PMC 8.44 PMC Request for Replacement of Draft

OMB #0581-0178
Form PMC 8.44

REOUEST FOR REPLACEMENT

TO:

The Prune Marketing Conunittee
3841 No. Freeway Blvd., Suite 120
Sacramento, Ca. 95834

OF DRAFT

Date:

The undersigned represents and states to the Prune Marketing Committee that draft No.

, dated

payment No.

for the sum of $

(based upon reserve pool
handler) issued by the Prune Marketing

prunes delivered to
Committee and payable to the order of the undersigned, has:

o
o
o

Not been received;
Been lost since its deliveryto the undersignedand can not be found;
That no person other than the undersignedpayee (or payees)has any interestin or right to said draft
and that the undersigned payee (or payee) is (are) entitled to receive for his (their) own account
payableaccordingto the tenns of saiddraft.

The undersigned hereby requests the Prune Marketing Committee to issue or cause to be issued to the undersigned
payee (or payees) another draft in place and stead of the draft so lost, and hereby agrees that if such other draft be so
issued the undersigned payee (or payees) will hold and keep the Prune Marketing Committee harmless from and
indemnified against any claim, demand, liability or loss arising out of or based upon said lost or missing draft, or the
presentment thereof hereafter for payment by any person claiming to be entitled to receive payment thereon:
Authorized Payees

Simatures

Addresses

INsrRUcnONS:
This form must be executed by any or all payees claiming loss or non-receipt of a surplus pool distribution
draft, precedent to the issuance of a replacement draft. A waiting period of 30 days is required before a replacement draft will be
issued. In the preparation of the form, the phrase at either (a), (b), or (c), whichever is applicable, must be checked
Accordingto the PaperworkReductionAct of 1995,an agencymay not conductor sponsor,and a person is not requiredto respondto a
collectionof informationunlessit displaysa valid OMBcontrolnumber. The valid OMBcontrolnumberfor this informationcollectionis
0581-0178. The timerequiredto completethis informationcollectionis estimatedto average3 minutesper response,includingthe timefor
reviewinginstructions,searchingexisting data sources, gatheringand maintainingthe data needed, and completingand reviewingthe
collectionof 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 or family status. (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 file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence
Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.