No Form number So. TX Onions Rept. of Special Purpose Onion Shipment

FEDERAL MARKETING ORDER #959

OMB NUMBER 0581-0178

SOUTH TEXAS ONION COMMITTEE
901 Business Park Drive, Suite # 500 Mission, TX 78572
Phone: (956) 584-9331 . Fax 584-0300

REPORT OF SPECIAL PURPOSE ONION SHIPMENT
(Date)

20

Handler Certificate of Privilege No.
Receiver
Address
Truck No.

Trailer No.
D Canning or Freezing

Print Carrier's Name

D Relief or Charity
D Other

Carrier's Signature
Carrier's signature acknowledges this shipment cannot be diverted to any other
receiver without contacting the handler.

Total Pounds

Quantity:
(ATTACH WEIGHT TICKET)

The undersigned certifies that these onions are in compliance with the regulations of Federal Marketing Order No. 959 for Onions Grown in South
Texas.

Handler

Signature
(0 BE COMPLETEDBY RECEIVER

Quantity Received
The undersignedacknowledgesreceipt of and certifies that the above onions will be diverted from fresh channels in accordance with the regulations of
the South Texas Onion Committee.

ReceMng Organization
ORIGiNAl
DUPLICATE

(white copy)

must be promptly mailed to the South Texas Onion Committee.

(canary copy)

and TRIPLICATE

(pink copy) shall be given to party receiving the onions. Upon arrival at destination,

both copies to the party actually receiving the onions, whereupon
Texas Onion Committee.
QUADRUPLICATE

Authorized Repres!!ntative

The TRIPLICATE

the party transporting

the onions shall give

said party shall insert the quantity of onions received, sign and promptly mail the CANARY copy to the South

(pink copy) may be retained by the receiver.

(gold copy) may be retained by Handler authorizing

The report is required by law (l CFR 959.322).

the movement

of onions from source.

Failure to report may result in a fine.

The following s1atements are made In accordance with the Privacy Act of 1974 (5 U.S.C. 5528) and the Paperwork ReOJctjon Act of 1995. The authority for requesting this Information to be supplied on this form is the
Agicult\.ral Marketing Agreement Act of 1937. Sees. 1-19.48 Stal31, as amended, (7 U.S.C. 601-674). FLmishing the requested Infonnation is necessary for 1he adminis1ration of1he marketing order program.
AccordIng to the Paperwork Reduction Act of 1995, an agency may not con<1Jct or sponsor, and a person Is not reqLired to respond to a collection of Information unless n displays a vald OMB control number. The valid
OMB control number for this Information collection Is 0581-0178. The time reqlired to co"1'lete this Information collection Is estimated to average 5 minutes per response, Including 1he time for reviewing lns1ructions,
searding existing data sources, gathet1ng and maintaining 1he data needed, and completing and reviewing 1he collection of Information.
The U.S. Oepartment of Agicuillre
(USOA) prohIbils discrimination in all lis programs and activities on 1he basis of race, color, national origin, age, disabllty, and where applcable, sex, marital s1atus, familal s1atus,
parental s1atus, religion, sexual orientation, genetic Information, poitical belefs, reprisal, or because all or part of an Individuafs Income Is derived from any pubic assis1ance program (Not all prohibited bases apply to all
progalllS.) Persons with dsabll1les who reQlire alternative means for commll1ication of prl)!J'8mInformation(Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and
TDO). To file a complaint of disaimination, wrtte to USOA, Oirector, Office ~ Civil RI!1IIs, 1400 Independence Avenue, SW.. Washington, D.C. 20250.9410, or cal (800) 79~272
(voice) or (202) 720-6382 (TDD). USDA
is an equal opportumy provider and employer.