U.S. USDA Form usda-ppq-626
FORM APPROVED
OMB NO. 0579-0076
Filing of this petition is required for remission or mitigation of seized property. Information
will be used in determining whether the petition is granted or denied (7 CFR 356).
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0579-0076. The time required to complete this information collection is estimated to average .50 minutes/hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE
FILE NO.
PETITION FOR REMISSION OR MITIGATION OF FORFEITURE
1. DATE AND TIME OF SEIZURE
TO:
USDA-APHIS
Plant Protection and Quarantine
2. PLACE OF SEIZURE
City
State and Zip Code
3. DESCRIPTION OF PROPERTY
4. NAME AND ADDRESS OF PETITIONER
5. EVIDENCE OF YOUR INTEREST IN THE PROPERTY SUCH AS CONTRACTS, BILLS OF SALE, INVOICES, CERTIFICATES OF TITLE, ETC., (Please attach copies of any documents)
6. STATEMENT OF ALL FACTS AND CIRCUMSTANCES RELIED UPON BY THE PETITIONER TO JUSTIFY REMISSION OR MITIGATION OF THE FORFEITURE
7. SIGNATURE OF PETITIONER OR PETITIONERS ATTORNEY AT LAW (If a business, the signature must be that of a partner, officer, or attorney at law)
PPQ FORM 626
(APR 2000)
Previous edition may be used.
8. DATE SIGNED