No Form number So. TX Onions Relief or Charity Certification, Fail to M

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OMS 0581-0178

RELIEF OR CHARITY CERTIFICATION
FOR HANDLING ONIONS WHICH FAIL TO MEET
THE SOUTH TEXAS ONION RULES AND REGULATIONS
20XX-20XX SEASON
Two (2) copies of this Certification are enclosed. If you receive onions which do not meet
the South Texas Onion Rules and Regulations, from South Texas onion handlers, to be
used for charitable or relief purposes, you must complete this certification and return one
copy to the South Texas Onion Committee office, retaining the other copy for your files.
I, THE UNDERSIGNED, HEREBY CERTIFY TO THE SECRETARY OF AGRICULTURE
AND TO THE SOUTH TEXAS ONION COMMITTEE THAT I HAVE READ, FULLY
UNDERSTAND, AND WILL COMPLY WITH THE FOREGOINGRULESWHICH GOVERN
THE HANDLING OF ONIONS WHICH FAIL TO MEET THE SOUTH TEXAS ONION
RULES AND REGULATIONS, AND FURTHERUNDERSTANDTHAT NON COMPLIANCE
IS A VIOLATION OF THE AGRICULTURAL MARKETING AGREEMENT ACT AND
SUBJECT TO A FINE OF UP TO $1,100 FOR EACH VIOLATION.
BY:
(Signature)

(print Name)

(Title)

(Firm Name)

[Date)

(Telephone Number)

(Fax Number)

(Street or Box Number, City, State, and Zip Code)

(Physical address ifdifferentthan above mailingaddress)

No shipments of special purpose onions may be made unless this form is completed and
returned to this Committee office (7 CFR 959.126).
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 OMS control number. The valid OMB control number for this information collection is
0581-0178. The time required to complete this information collection is estimated to average 5 minutes 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 an prohibited bases apply to all programs.) Persons with alSabirJtieswho require alternative means for
communication of program information (Braine,1arge 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 CivilRights, 1400 Independence Avenue, S.W.,
Washington, D.C. 20250-9410, or caD (800) 795-3272 (voice) or (202) 72Q..6382 (IDD). USDA is an equal opportunity provider and

employer.