No Form number ID/E.OR Potatoes Certificate of Privilege Shipment Summa

OMS No. 0581-0178

IDAHO-EASTERN OREGON POTATO COMMITTEE
Administering
Federal Marketing Order No. 945

Mail to:

1775 E. 17th Street
Idaho Falls, Idaho 83403
Phone: (208) 529-8057
Fax: (208) 529-8057

P.O. Box 2192

CERTIFICATE OF PRIVILEGE SHIPMENT SUMMARY
Dear Handler:
You were issued a Certificate of Privilege for Special Use, grade exempt shipments of
potatoes.
Marketing Order regulations require that a report, on completion of each sales contract, be
filed with the Administrative Committee. Failure to file a report may be deemed sufficient
reason to deny future applications for Certificate of Privilege.
Please complete and return the lower section of this letter. If no potatoes were shipped,
please indicate.

Permit Number

Receiver

Firm Name

Total CWT Shipped

Signature

Date

Aceotrling 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 informa/jon unless it displays a valid
OMS control number. Tha valid OMS control number for this information collection is 0581'()178. Tha time required 10 complete this information collection is estimated 10 average 10
minutas 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 informa/jon.
Tha 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,
merilal status, familial status, parental status, religion, sexual orienta/jon, genetic informa/jon, 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 communice/jon of program informa/jon (Braille, large
print audiotape, ete.) should conlect USDA 's TARGET Center at (202) 720-2(J()()(voice and TDD).
To file a complaint of discrimination, write to USDA, Director. OffICe of Civil Rights, 1400 Independence
(202)

720-6382

(TDD). USDA

is an equal

opportunity

provider

and employer.

Avenue, S. w., Washington, D.C. 20230-9410. oreall (BOO) 795-3272 (voice) or