Usda Lacey Act Declaration Page 4

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Version 12-08-2008-0856
15.
Country of Harvest: Enter the country of origin (where the plant was harvested) (example:
See below). If the country of harvest varies, and is unknown, enter all countries from which
the plant material in the product may have been harvested.
16.
Quantity of Material: How much product/merchandise is in the shipment (example: See below).
17.
Unit of Measure: Use the drop down box on the form to enter the units for #17.
(example: See below).
doz - dozen
kg - kilograms
m - meter
m
- square meters
2
m
- cubic meters
3
No. - number
pcs - pieces
t - metric tons
bf - board feet
18.
% Recycled Material: If the product is paper or paperboard, enter the percentage of recycled
material it contains (0 - 100%). If the percentage of recycled material varies, enter the average
percentage of recycled material used in the product (example: If the percentage of recycled
material used is between 25% and 45%, enter 35%).
14. PLANT SCIENTIFIC
13. ARTICLE/COMPONENT OF
15. COUNTRY OF
16. QUANTITY OF
17. UNIT OF
18. % RECYCLED
NAME: (Genus and
ARTICLE:
HARVEST:
PLANT MATERIAL:
MEASURE:
MATERIAL
Species)
Tables made of Ramin Wood
Gonystylus spp.
Indonesia
500
No.
15
European ash lumber (2" x
Fraxinus excelsior
Switzerland
352,000
BF
0
4')
Note: Sign and Print your name, and write the date on both sections of the form.
2

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