PMC 10.1-A PMC Application for Prune Plum Diversion Independent Pro

APPLICATION
FORPRUNEPLUMDIVERSION
INDEPENDENT
PRODUCER

Form PMC 10.1-A
OMS No. 0581-0178

1. Date:

1:0: PRUNE MARKETING COMMITTEE

The undersigned hereby certifies that all information contained in this application is true and correct to his beSt
knowledge and belief and that he held proprietary interest in the prune plums for diversion as of July 1,2001.
2.

Name of Producer:
A. Producer
Number

(PLEASE PRINT)

3. Address:

B. Application
roved
C. Field
Office

4. ProducerStatus: OwnerOperatorU; ShareLandlordU;
(CHECK
ONE)
1
2
ShareTenant U; Cash Tenant U;
3
4

Telephone
Number

DIVERSION
HARVESTED

UNHARVESTED

TOTAL

5. MaximumGreenTonsApplied for

-- ------- ---

6. County(les) of Production

7.

Variety (ies) of PrunePlums

I

DumD

-- --

8. Locationof
Diversion

9. DiversionDeposit:
If Line 5 Total is 28.5 GreenTonsor lessthe minimumdepositis $100
OR
) x $3.50. . . . . . . . . . . . . .
If Line 5 Total is greaterthan 28.5 GreenTons: (

$

Une5TotaI

FOR PMC USE ONLY
10.

Orchard Operator's Name:
(IF DIFFERENTTHANLINE2)

D. AMOUNT
I!. CHI!CK
NUMBER

11. Applicant's Name:
(PLEASE PRINT)

12.

Applicant's

Address:

13.

Applicant's

Signature:

14.

Telephone Number:

. DATI!
RECEIV!D
. aANl\

NUM8I!R
H. ACCOUNT
(AREA CODE)

15. Mail to:

.

(NUMBER)

I. SIGNATORV

PRUNE MARKETING COMMITTEE, 3841 NORTH FREEWAY BLVD., STE.120, SACRAMENTO,CA

READ INSTRUCTIONS
ON REVERSE SIDE
FILLING OUT APPLICATION

PRIORTO

95834

INSTRUCTIONS
INDEPENDENT PRODUCER
A.
B.
C.
D.
E.

Please study the example before filling out your application on the reserve side of this sheet.
Do not write anvthina In the block marked "For PMC Use Only".
Be sure the application is otherwise 'completed in full to avoid rejection.
If you are a dehydrator or green fruit buyer acting as a diversion agent for one or more producers, please contact.
PMC/Sacramento for special instructions in filling out your application (s).
The following instructions are numbered to correspond to the line numbers on the application.
1. Fill in the data on which the application is filled out.
2. The name of the producer on line 2 should be the same as the name of the applicant on line 11, UNLESS:
The producer is a partnership or a corporation, or is otherwise doing business as an entity other than in the
name of the applicant. If applicant's name is not the same as that shown on line 2, applicant should enter Q!l
line 11, after his name, his position such as "Partner-, "Manager-, "Executor-, "President", "Owner-, or
whatever other title best describes his authority to make application.
3. Address of 2.
4. On line 4, check the box that applies to the status of the producer named on line 2. For example, if the name
on line 2 is the Share Landlord, check box #2 on line 4, and if you as the applicant are the Share Tenant on
the property, enter "Share Tenant" on line 11 after your name.
5. On line 5, enter in each box the areen tons you intend to divert (not dried equivalent). If you intend to divert
only HARVESTED (DIpper), enter the green tons applied for In the "Harvested" box, enter NONE in the
"Unharvested" box, and repeat the figure entered in the "Harvested" box in the "TOTAL" box. If you Intend to
divert both harvested and unharvested, enter In the appropriate box the green tons to be diverted by each
method, and show the total in the "TOTAL.box.
6. The county (les) in which the prune plums for diversion were actually produced.
7. The variety (ies) of prune plums to be diverted. If Interplants, enter the predominant varieties and the
percentage of each variety.
8. The physical location where diversion will take place. Provide sufficient instructions to allow PMC
representatives to locate the diversion location.
9. The amount on line 9 will be at least $100. If you are applying for more than 28.5 tons multiply the total tons
applied for by $3.50, and enter this amount on line 9.
10. Print the title (ranch foreman, manager, etc.) and name of the person to be contacted at the diversion
location if other than the applicant.
11. See NO.4 above.
12. Mailing address to which applicant wants diversion information sent if different from line 3 above.
13. Signature of person qualified to authorize diversion.
14. Telephone number at which you can be reached to answer a question on your diversion during the day. If
you are only there during certain hours of the day so Indicate, for example (916) 123-4567 (12:00 1:00
p.m.).
15. Mail your application to this address. If you have any questions on the information required on the balance of
the application form, please call (916) 565-6235, or write to the address shown on line 15 of the application.

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IMPORTANT NOTICE
The issuance of a false certificate knowing it to be false is a violation of Title 18, Section 1001 of the United States Code, which provides a penalty
of a fine of not more than $10,000 or imprisonment of not more than 5 years or both.
AlITHORITY: § 993.62 ofMaIketing Order No. 993, as Amended, and § 993. 162(c) of the Administrative Rules and Regulations established
pursuant thereto.
According to the Paperwork Reduction Act of I 995, 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 0 MB control number. The valid 0 MB control number for this information collection is 0581-0178. The time required
to complete this information collection is estimated to average 10 minutes per response, including the timefor 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, gender, religion, age, disability, political
beliefs, sexual orientation, and marital orfamily status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative
meansfor communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice
and TDD). Tofile a complaintof discrimination,writeUSDA,Director,Officeof CivilRights,Room326-W,WhittenBuilding,1400IndependenceAvenue,
SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.