U.S. Department of Agriculture Grain Inspection, 

Packers and Stockyards

Administration

Packers and

Stockyards

Program

List owners, officers, partners, and members in control of this business

Type of organization: Individual Partnership Corporation L.L.C. L.L.P. Co-op Association Other

Did any change in organization take place during the year? Yes No

List State Incorporated/Registered/Formed Date Incorporated/Registered/Formed

Total cost of all livestock purchases for your account

Total sales value of all meat and meat food products handled by the firm.

Yes No

Yes No

Yes No

Yes No

Yes No

Manual Filing

210

COST OF LIVESTOCK PURCHASED - SECTION 3

ORGANIZATIONAL STRUCTURE - SECTION 2

205

204

203

201

Legal Business Name

City, State, Zip

103 Business Name (dba)

105

Physical Address

Contact Name

Fax Number

E-Mail Address Web Address

a. Name c. Percentage Ownership

111

110

112

108

Electronic Filing

PACKER INQUIRY

107 City, State, Zip

104 Mailing Address

106

109 Telephone Number

101 Reporting Period 

(mm/dd/yy) a. from b. to

102

P&SP Bar Code Only

$

$

Business Entity ID Number

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 P&SP Central Reporting Unit. See separate instructions for complete information about this report. 

GENERAL INFORMATION - SECTION 1

for P&SP Stamp Only

Indicate your preference to submit forms 

electronically, or by paper copy

209

Number of days livestock was purchased during the reporting year

402

206

JURISDICTION - SECTION 4

If line 207 is "Yes", give details

301

202

b. Title

404 Does the firm purchase livestock for slaughter from outside the State in which slaughtered?

405

406

407

403

401

207

Does the firm sell or ship any meat or meat food products outside the State where such meat or meat food products are manufactured or 

prepared by it?

Does the firm purchase livestock for slaughter at terminal stockyards or auction markets?

Does the firm sell or ship meat or meat food products manufactured or prepared by it to the U.S. Government agencies (i.e. military 

installations, hospitals, etc.)?

Do you operate as a wholesale broker, dealer, or distributor in commerce to market meat, meat food products, or livestock products in an 

unmanufactured form?

208

Form 1400 Expires 11-30-2017 Page 1 of 2
Use this space for additional information or explanation, making reference to item number.

OMB No. 0580-0015

CERTIFICATION - SECTION 7

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 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 2 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.

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.

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 702 Signature (Must be signed by a person listed on 201-205)

703 Phone Number 704 Date 705 Title

502 By the firm for the accounts of others (i.e. Custom Killed)

503

LIVESTOCK SLAUGHTERED - SECTION 5

501 By the firm for its own account.

Cattle Calves Hogs Sheep/Goats

Number of Head

REMARKS - SECTION 6

By others for the firm's account. (i.e. Custom Killed for the firm at other 

locations).

601

Note: Under Remarks (Section 6), list name and address of each person or firm for or by whom at least 1,000 head were slaughtered and indicate whether it 

applies to lines 502 or 503.

Form 1400 Expires 11-30-2017 Page 2 of 2