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INFORMATION FOR REPORTING COMPLAINTS ON USDA DONATED COMMODITIES Recipient Agency Name: Address: City: Contact Person: State: MO Title: Phone #: Fax #: Commodity Name & Commodity Code: Date Complaint Filed: Description of Problem/Complaint: REASON FOR COMPLAINT Seeking Replacement Vendor Response Requested Isolated Incident; Notify Vendor (no response nec.) For Information Only Other (specify): IMPORTANT INFORMATION NEEDED TO RESEARCH COMPLAINT (Please fill in as much.

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