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[{"$nulls":5},"For P&SP Use Only",{"$nulls":8},"P&SP Bar Code Only"]
{"$rows_empty":7}
["U.S. Department of Agriculture",{"$nulls":4},"STATUS OF CUSTODIAL BANK ACCOUNT FOR SHIPPERS' PROCEEDS SPECIAL REPORT"]
["Grain Inspection, "]
["Packers and Stockyards"]
["Administration"]
[]
["Packers and",{"$nulls":4},"Instructions: If an item's value is zero, enter \"0\". If an item does not apply, enter \"NA\". Upon completion please verify that all items have been answered. Return completed form to the appropriate P&SP regional office.  See separate instructions for complete information about this report."]
["Stockyards"]
["Program"]
[]
[{"$nulls":10},"GENERAL INFORMATION - SECTION 1"]
[]
[101,null,null,"Date of Report (mm/dd/yy)"]
[102,null,null,"Legal Business Name"]
[103,null,null,"Business Name (dba)"]
[104,null,null,"Mailing Address"]
[105,null,null,"City, State, Zip"]
[106,null,null,"Physical Address"]
[107,null,null,"City, State, Zip"]
[108,null,null,"Contact Name"]
[109,null,null,"Telephone Number"]
[110,null,null,"Fax Number"]
[]
[{"$nulls":9},"CUSTODIAL ACCOUNT INFORMATION - SECTION 2"]
[]
[201,null,null,"Name of Bank"]
[202,null,null,"Mailing Address"]
[203,null,null,"City, State, Zip"]
[204,null,null,"Telephone Number"]
[205,null,null,"Bank Contact Name"]
[]
[{"$nulls":9},"CUSTODIAL ACCOUNT DESIGNATION - SECTION 3"]
[]
[301,null,null,"Designation or Title of Custodial Account on Bank Statement"]
[302,null,null,"Designation or Title of Custodial Account on Checks Issued"]
[]
[{"$nulls":7},"ANALYSIS OF CUSTODIAL BANK ACCOUNT FOR SHIPPERS' PROCEEDS - SECTION 4"]
[]
[null,null,null,"Bank statement balance:",{"$nulls":9},401,"$"]
[null,null,null,"Deposits in transit (in mail or bank, but not on statement)",{"$nulls":9},402,"$"]
[null,null,null,"CD's and savings accounts designated as custodial funds",{"$nulls":9},403,"$"]
[null,null,null,"Proceeds on hand",{"$nulls":9},404,"$"]
[null,null,null,"Proceeds receivables (show details in Section 5 of this report)",{"$nulls":9},405,"$"]
[null,null,null,"Total debits",{"$nulls":14},406,"$"]
[null,null,null,"Outstanding checks and drafts that have not cleared bank",{"$nulls":9},407,"$"]
[null,null,null,"Proceeds due consignors of livestock for which no checks were issued",{"$nulls":9},408,"$"]
[null,null,null,"Expense items related to sales remaining in account",{"$nulls":9},409,"$"]
[null,null,null,"Total credits",{"$nulls":14},410,"$"]
[null,null,null,"Overage in account (debits exceed credits)",{"$nulls":14},411,"$"]
[null,null,null,"Shortage in account (credits exceed debits)",{"$nulls":14},412,"$"]
[]
[{"$nulls":9},"PROCEEDS RECEIVABLE - SECTION 5"]
[]
[null,null,null,"“Proceeds Receivables” vary based on the livestock buyer. For most buyers when conducting the custodial analysis any uncollected funds during the time period including the analysis date and the 6 days before the analysis are proceeds receivables.  For livestock purchases made by the market, its owner, officers, employers, and credit buyers the time period is limited to include only the analysis date and the previous business day."]
[null,null,null,"Date of Sale",null,null,null,"Name of Buyer",{"$nulls":11},"Amount of Proceeds Receivable"]
[501,{"$nulls":18},"$"]
[502,{"$nulls":18},"$"]
[503,{"$nulls":18},"$"]
[504,{"$nulls":18},"$"]
[505,{"$nulls":18},"$"]
[506,{"$nulls":18},"$"]
[507,{"$nulls":18},"$"]
[508,{"$nulls":18},"$"]
[509,{"$nulls":18},"$"]
[510,{"$nulls":18},"$"]
[511,{"$nulls":18},"$"]
[512,{"$nulls":18},"$"]
[513,{"$nulls":18},"$"]
[514,{"$nulls":18},"$"]
[515,{"$nulls":18},"$"]
[516,{"$nulls":18},"$"]
[517,{"$nulls":18},"$"]
[518,{"$nulls":18},"$"]
[519,{"$nulls":18},"$"]
[520,{"$nulls":18},"$"]
[521,{"$nulls":18},"$"]
[522,{"$nulls":18},"$"]
[523,{"$nulls":18},"$"]
[524,{"$nulls":18},"$"]
[525,{"$nulls":18},"$"]
[526,{"$nulls":18},"$"]
[527,{"$nulls":18},"$"]
[528,{"$nulls":18},"$"]
[529,{"$nulls":18},"$"]
[530,{"$nulls":18},"$"]
[531,{"$nulls":18},"$"]
[532,{"$nulls":18},"$"]
[533,{"$nulls":6},"Total from Additional Pages (enter 0 if no other pages used)",{"$nulls":11},"$"]
[534,{"$nulls":6},"Total Proceeds Receivable (enter on line 405)",{"$nulls":11},"$"]
[]
[{"$nulls":10},"CERTIFICATION - SECTION 6"]
["Under the Packers and Stockyards Act any person who willfully makes, or causes any false entry or statement of fact in this report shall be deemed guilty of offense against the United States, and be subject to a fine of $1,000 to $5,000, or to imprisonment for a term of not more than 3 years, or to both fine and imprisonment."]
[]
["I certify that this report has been prepared by me or under my direction, and to the best of my knowledge and belief correctly reflects reporting entity operations."]
[" 701 Print Name",{"$nulls":11},"702 Signature (Must be signed by a person listed on 201-205)"]
["703 Phone Number",{"$nulls":7},"704 Date",null,null,null,"705 Title"]
[]
["Submitted information is confidential (9 CFR 201.96).  Failure to report will result in forfeiture to the United States $110 per day until report receipt 7 (U.S.C. 222).  Response is required in order to determine establishment, maintenance and status of custodial account (9 CFR 201.97).  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 is 0580-0015. The time required to complete this information collection is estimated to average 1 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection."]
[]
["The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program.  (Not all prohibited bases apply to all programs.)  Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).  To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).  USDA is an equal opportunity provider and employer."]

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