<p> DESTINATION VERIFICATION FOR THE DELIVERY OF USDA COMMODITIES</p><p>Name of State Agency: Kentucky Department of Agriculture, Division of Food Distribution</p><p>Name of Processor: </p><p>Federal Establishment #: </p><p>Facility name and address for the RECEIPT of USDA commodity and / or commodities (specify USDA commodity name and code i.e. Large Chickens A 522):</p><p>Contact Person: </p><p>Email: </p><p>Telephone Number (include area code): </p><p>Fax Number (include area code): </p><p>Plant location, if different from the facility listed above. If processing at more than one plant, please specify USDA commodity and end product for each plant location:</p><p>Contact Person: </p><p>Email: </p><p>Telephone Number (include area code): </p><p>Fax Number (include area code): </p><p>Signature of the Authorized Representative of the Processor Date Signed</p><p>ACDA 10/06</p>