CDAC-2 CA Dates--Report of Exempt Sales

CDAC Form #2

Send one signed copy to:

California

Date Administrative

Committee

P.O.Box 1736, India, CA 92202-1736
Facsimile: 760.347.6374

Report of Exempt Sales
(Section 987.65 and 987.165)epproved for OM8#0581"()178

This report must be filed immediately after the completion of all sales and/or by September 3D, the end of the crop year. The
following quantities of Dates were sold by me or the organization

-

I represent during the

crop year in the

manner described below under the exemption(s) granted by the Califomia Date Administrative Committee.

Directly to consumers
at my own roadside
stand or date shop

Variety

Directlyto consumers
shipped by parcel
post or express

Other (under handler
exemption specified
on my application)

(State in terms of pounds of whole dates)

Deglet Noor

Halawy

Khadrawy

Zahidi

o

Total Pounds (Ibs.)

o

o

I hereby certify to the U.S. Department of Agriculture and the Califomia Date Administrative Committee that the information contained
in this report is complete and correct.

Handler or Producer:

By:
Date:

Signature:

The making
Imprisonment
$5,000

oftalse

statemant

or representation

on this fonn, knowing

of not more than five years, or both. This report

for each such violation

and each day during which

R to be false,ls

Is required

such violation

bylaw

a violation

Title:

of TItle 18, section

1000, United

(7 USC 608(d), CFR 987.51 and 7 CFR 987.151).

continues

shall be deemed

a separete

States
Failure

code, which provides
to report

for the penalty

of a rUle of $10,000

or

can result In a fine 01 not less than $50 or more than

violation.

According to the PapelWOrk Reduction Act of 1995, an agency may not condud: or sponsor, and a person Is not required to respond to a collection of Information unless It displays
a vaRdOMBcontrol number. The validOMBcontrol number for this informationcollectionIs 0581-0178. The time requIredto complete this InformationcollectionIs estimated to
average 12 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 Information.
The U.s. Department of Agriculture (USDA) prohibits dlsatmlnaUon In all Its programs and actMUes on the basis of race, color, national origin, age, disability, and where applicable,
sex, marital sI:at1Is,familial sI:at1Is,parental status, religion, sexual orientation, genelfc Information, poIitfc:albeliefs, reprfsal, or because all or part of an IndMduars Income Is
derived from any public assIstance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for convnunlcatlon of program
Information (Braille, large print, audiotape, etc.) should contact USDA's TARGETCenter at (202) 720-2600 (voice and lDD). To file a complaint of discrimination, write to USDA,.
Director, 0fIIce of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 79S-3272 (voice) or (202) 720-6382 (TDD). USDAIs an equal
oppoltunlty provider and employer.