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 0MB control number. The valid 0MB control number for this information collection is 0583-0153. The time required to complete this information collection is estimated to 

average 25 minutes per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and 

reviewing the collection of information. 

U.S. DEPARTMENT OF AGRICULTURE 

FOOD SAFETY AND INSPECTION SERVICE 

Meat and Poultry Export Certificate of Wholesomeness 

1. COUNTRY OF DESTINATION 2. ISO CODE 

[Importing Country Name] XX

3. CONSIGNOR/EXPORTER (Applicant's name and address)

Exporter Name

Street Name 

City Name, State zip code 

UNITED STATES 

4. CONSIGNEE/IMPORTER (Name and address)

Importer name

Street Name

City Name

[Importing Country Name]

10. 

DESCRIPTION OF PRODUCT 

(Name of product)

11. 

NET WEIGHT OF 

LOT' 

Product 1 100 lbs 

(45.3592 kgs)

1As stated by applicant or contractor 

17. REMARKS

See additional remarks on the continuation sheet. 

A knowingly false entry or false alteration of any entry on this certificate may result in a fine of not 

more than $10,000 or imprisonment for not more than five years or both (18 U.S.C. 1001). 

Additional penalties exist under the Federal Meat Inspection Act [21 U.S.C 611 (b) (1 ), (2); and 

(5), 21 U.S.C 461] for an unauthorized or false alteration or misuse of this certificate. 

5. CERTIFICATE NUMBER

0155398

6. CERTIFICATE TYPE 

0 ORIGINAL 

□ REPLACEMENT

PRODUCT EXPORTED FROM: 

7. EXPORT EST. NO. (Name and address)

P38

Export Family Name

Street Address

City Name, State zip code

8. TOTAL NET WEIGHT

100 lbs (45.3592 kgs)

9. TOTAL NO. OF PACKAGES

100

13. 16.

12. NUMBER OF

14. 

TYPE OF EST. NO. 

SPECIES PACKAGES PACKAGES ON

IN LOT' IN LOT' 

15. 

SHIPPING/ 

IDENTIFICATION 

MARKS' PRODUCT

Chicken 100 Case P38

18. I CERTIFY that the meat, meat food product or meat byproduct specified hereon is from animals that received both antemortem and postmortem 

inspection and were found sound and healthy and that it has been inspected and passed as provided by law and regulations of the Department and is sound 

and wholesome. 

D 

19. I CERTIFY that the poultry, poultry products or poultry food products specified above came from birds that were officially given an antemortem and 

postmortem inspection and passed in accordance with applicable laws and regulations of the United States Department of Agriculture and are wholesome 

and fit for human consumption. 

NOT VALID UNLESS SIGNED BY A CERTIFYING OFFICIAL OF MEAT, POUL TRY, AND EGG PRODUCT INSPECTION SYSTEM 

20. CERTIFYING OFFICIAL'S NAME AND TITLE 21. DATE SIGNED (MM/DD/YYYY) 

By order of the MICHAEL TENARD

U.S. Government, Department of Agriculture 

PHIS ID: U-FSIS-37224;0533853 

Date: 07/20/2023 10:46:43 

Secretary of Agriculture 

MICHAEL TENARD, DVM Alameda, CA 07/20/2023 

This certificate is receivable in all courts of the United States as prima facie evidence of the truth of the statements therein contained. 

This certificate does not excuse failure to comply with any of the regulatory laws enforced by the United States Department of Agriculture. 

FSIS FORM 9060-5 (06/29/2018) ALL PREVIOUS EDITIONS OBSOLETE ORIGINAL 

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