Usda Lacey Act Declaration Page 2

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Plant and Plant Product Import Declaration

(cont.)

SECTION 2 - Compliance with Lacey Act Requirements (

16 U.S.C. 3372(f))

10. DESCRIPTION OF MERCHANDISE:

11. HTSUS NUMBER:

12. ENTERED VALUE:

(in U.S. Dollars)

For each article or component of an article, provide the following:

13. ARTICLE/ COMPONENT OF

14. PLANT SCIENTIFIC NAME:

15. COUNTRY OF

16. QUANTITY OF

17. UNIT OF

18. % RECYCLED

ARTICLE

(Genus and Species)

HARVEST:

PLANT MATERIAL:

MEASURE:

MATERIAL:

I certify under penalty of perjury that the information furnished is true and correct:

Signature

Type or Print Name

Date

Knowingly making a false statement in this Declaration for Importation may subject the declarant to criminal penalties in accordance with 16 U.S.C. 3373(d).

PPQ FORM 505

Version 12-08-2008-0856

Page 2

DECEMBER 2008