RAC-1001 CA Raisins--Schedule for Redemption of Raisin Diversion

RAC-1001
Revised 12/06
(Submitin Duplicate)

SCHEDULE FOR
REDEMPTION OF RAISIN DIVERSION CERTIFICATES
Crop Year
RAISINADMINISTRATIVECOMMITTEE
P.O. Box 5217
Fresno, CA 93755-5217
Schedule

Office of Management & Budget
Control Number 0581-0178

No.

The undersigned Handler hereby requests release of reserve pool raisins to fulfill redemption of Raisin Diversion
Certificates attached
Creditable
Creditable
Creditable
Certificate
Diversion
Certificate
Diversion
Certificate
Diversion
#
#
#
Weiaht Ibs.
Weight Ibs.
Weight Ibs.

Ibs

Total Creditable Diversion Weight
Multiplied by $

=

$
RAC RELEASE NO.

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.

Handler

By.

Title

Date

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 6 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 roD). To file a complaint of discrimination, write to USDA, Director, Office of
Civil Rights, 1400 Independence Avenue, S.w., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (lVD). USDA is an
equal opportunity pravider and emplaye r.