RAC-106 CA Raisins--Application to Purchase Reserve Pool Raisins

APPLICATION TO PURCHASE RESERVE POOL RAISINS TO FULFILL
AN "OFFER TO SELL" PURSUANT TO ANNOUNCEMENT FVRAISIN ADMINISTRATIVECOMMITTEE
P.O. Box 5217
Fresno, CA 93755-5217
Contract Number

RAC-106
Revised 12/06
(submit in duplicate)

Office of Management and Budget
Control Number 0581-0178

The undersigned Packer hereby requests approval by the Raisin Administrative Committee of this application. It is understood that upon approval of this application,
the Packer has agreed to purchase and the Raisin Administrative Committee has agreed to sell the quantity of natural condition raisins specified herein for use in
fulfilling the Packer's accepted "Offer to Sell" pursuant to U.S. Department of Agriculture's Announcement FVInvitation

VarietalTvpe

Net Pounds Per
Shippina Case

Numberof
Shippina Cases

Total
Net Pounds
Packed Weight

Factor
Per
FV

Equiv. Natural
Condition Weight=
Packed Weight
DividedBv Factor:

Amountto be
Invoiced at
$
per ton
I.
per lb.)

Total
As a condition to RAC approval of this application and in conformance with Section 989.73(d) of the Marketing Order the undersigned Packer agrees to furnish to RAC one copy of the
commercial bill of ladin and one co y of the USDA Ins ection Service's Certificate of loadin relative to each shi ment of raisins from the tonnage released ursuant to this a licatie
The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a
violation of Title 18, Section 1001, United States Code, which provides for a penalty of a fine of $10,000 or imprisonment of not more than five years, or both.

PACKER NAME AND ADDRESS
FOR RAC USE ONLY

Packer
Address
Officer Title

(Signature)
This report is required by law (7 U.S.C 608 (d), 7 CF.R. 989.173 (a)(3». Failure to report can resuIJ in afme of$1,100for each such violation and each day
during which such violation continues shall be deemed a separate violation.
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 OMB
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 10 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 all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print,
audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To flIe a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 14000
Independence Avenue., S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.