Form Approved OBM No. 0581-0032

U S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

DAIRY PROGRAMS

ANNUAL REPORT OF COOPERATIVE MILK MARKETING ASSOCIATION

(Including actions taken at the annual meeting following close of the year)

FOR FISCAL YEAR ENDED

PLEASE RETURN ORIGINAL TO:

USDA-AMS-DAIRY PROGRAMS

CHIEF, ORDER OPERATIONS BRANCH

ROOM 2753-SOUTH, STOP 0226

1400 INDEPENDENCE AVE., SW

WASHINGTON, DC 20250-0226

NOTE:

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection or information unless it displays

a valid OMB control number. The valid OMB control number for this information collection is 0581-0032. The time required to complete this information collection is estimated to 

average 15 minutes 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. This report is required by 7 CFR 900.355 from cooperatives desiring to maintain their qualification as a cooperative association under the 

Federal Milk Order Program. Failure to report can result in termination of your qualification as a cooperative.

The U.S. Department of Agriculture (USDA) prohibits discrimination in its programs on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, and 

marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, 1400 Independence Avenue, SW, Washington, DC 20250-9410, or call 202-720-5964

(voice and TDD). USDA is an equal opportunity provider and employer.

CURRENT NAME AND ADDRESS OF ORGANIZATION (Complete Mailing Address) TELEPHONE NO.:

Name: FAX NUMBER:

Add1: E-MAIL ADDRESS: 

Add2:

City: State: Zip:

Complete each item. Submit all requested information to Dairy Programs at the above address. Send a copy of this

completed form and all requested information to the market administrator of each Federal milk order you list in item 8.

YES NO

1. Were any amendments made to the Articles of Incorporation? (If “Yes “, submit a copy of the amendments or a copy of the

Articles now in force as amended.)

2. Were any amendments made to the Bylaws? (if “Yes”, submit a copy of the amendments made or a copy of the Bylaws now

in force as amended.)

3. Was the form of membership certificate, membership contract or producer marketing agreement changed? (if “Yes”, submit

a copy of the new form.

4. Were the stock certificates changed during the year? (if “Yes”, submit copies of the new certificates.)

5. Submit a copy of your Balance Sheet at the close of the year and a copy of all auditor’s notes and reports.

6. Submit a copy of the Operating Statement for the year, with supporting schedules and notes showing sources of income.

7. Submit a list of officers and members of the Board of Directors and give the length of service for each individual as an

officer and director, and the date the present term expires. Also, submit a list of principal employees and position titles.

8. GRADE A PRODUCERS, BY INDIVIDUAL FEDERAL ORDER MARKET, AS OF END OF FISCAL YEAR

NAME OF FEDERAL ORDER MARKET NO. OF PRODUCERS

 9. Number of Grade A producers delivering to plants operated by the association.

10. Number of Grade B producers. 

11. Number of inactive and retired members with voting rights.

12. Value of nonmember business during year.

13. If stock dividends were paid, list the class stock and dividend rate on each class. 

 

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DA-24 (01-04) (Continued on next page)
14. Describe in detail any changes during the year in your marketing services program for Grade A producers. Distinguish by markets, plants, or other operating units.

Cover methods and frequency of sampling, butterfat testing and your weight verification program for farm bulk tanks.

15. Submit a recent copy of your market information publication sent to Grade A producers, stating how frequently such publication is sent. (If a publication is not

used to provide Grade A producers with market information, explain how this information is provided).

CERTIFICATION

I certify that no officer, director, manager, or principal employee or any of their close relations has a financial interest in any competitor of the Association or in

any business organization selling to or purchasing from the Association, other than the person’s own farm. I also certify that the information herein and in

the accompanying documents and schedules is true, correct, and complete to the best of my knowledge.

NAME OF ASSOCIATION

DATE (Mo., Day, Yr.) SIGNATURE AND TITLE OF REPORTING OFFICIAL

DA-24 Reverse (01-04)