CDAC-11(a) CA Dates--Clearance for Export of Dates to Mexico

OMS No. 0581-0178
CDAC Form #11(a)

Send one signed copy to:

CaliforniaDateAdministrativeCommittee
P.O.Box1736,IndloCA92202.1736
CLEARANCEFOREXPORTOFDATESINTOMEXICO
(Section987.64, 987.65and 987.164, 987.112a(d)(3) .pprolled for use OMBII0581-o178

,

locatedat
(Buyer's Name)

(Addl8SS)

{City}

VARIETY

{State}

CLASSIFICATION: USDAINSPECTION
EXPORTMEXICO CERT'orREPORT NUMBEROF
OROTHER
GRADING
.
CONTAINERS

TYPEOF
CONTAINERS

(Zip)

NETWT.

Carrier (truck driver) states that he will leave CaDfomia and enter Mexico at
(point of Entry)

and his entry date will be about
I HEREBY CERTIFYto the U.S. DEPARTMENTOF AGRICULTUREandthe CAUFORNJADATEADMINISTRATIVECOMMITTEEthat the above
described dates have been sold to tile above named buyer under an agreement that he will enter them Into Mexico, that he will not re-export them
to the United States or Canada, and that he holds a valid license from the Govemment of Mexico to Import dates:
Selling Handler:
Signature of authorized agent:

Title:

Date:

DISTRIBUTION:
Originaland one copyto truckdriverto be surrenderedto U.S.Customs at Mexican border. (AI operador del eamlon ara entregar
81U.S. Customs en la frontera Mexleana.) Copy to be sent to Callfomla Date Administrative Committee by lelllng handler.
The mailingor,.. statellllnt or npI8I8ntat1on on till. form. IInowtngIt to befal.., Is I violation ofTltI. 11,uc:IIon 1000,UnitedStIt8. Code, which provld.. for the
p.nalty of a fine of S10,oooor Imprl.onm.nt of not more than five yelre, or both.
nil report II requiredby law(7USC8OI(d),7 CFR887.84,7 CFR..U5lnd 7 CFR887.184,7 CFRU7.112a (d) (3). Filiure to report can result In I fin. ofnotl... thin
$50 or more thin $5000for .ach .uch violation Ind each day during which such violationconUnu.. .h,ll be dHm.d a IIplrate 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 Infonnatlon unless It displays
a vaRd OMS control number. The vaUd OMS control number for this Infonnatlon collection Is 0581-0178. The time required to complete this Infonnatlon collection Is estimated to
average 20 minutes per response, Indudlng the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of Infonnatlon.
The U.s. Department of AgrlaJlture (USDA) prohibits dlsalmlnatlon 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 Infonnatlon, political beliefs, reprisal, or because all or part of an Indlvlduafs Income Is
derived from any public assistance program (Not all prohibited bases apply to all programs.) PeISOns with disabilities who require alternative means for communication of program
Infonnatlon (Braille, large print, audiotape, etx:.) should contact USDA.sTARGET Cenb!r at (202) 720-2600 (voice and lDD). To file a complaint of dlsalmlnatlon, write to USDA,
Director, Office of Ovll Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (roD). USDAIs an equal

opportunity
providerandemployer.

.