PMC 4.9 CA Dried Prunes Affidavit of Diversion

Form PMC 4.9
OMB OS81~178

AFFIDAVIT OF DIVERSION
STATE OF CALIFORNIA
COUNTY OF
The undersigned being first duly sworn. deposes and says:
TIlAT the following prunes were purchased &om

; thaton or before
. 20_
said pruneswere used
; andthat he is duly authorizedto makethis affidaviton

by
for
behalf of said Buyer.
PMC
InvoiceNo.

Seller's Contractor
InvoiceNumber

Subscribed and sworn to before me, this

Signature

Date
Received

Pounds

day of
Title

Finn

Notarv Public in and for said Countv and Stat~
DIVERSION CERTIFICATE
The undersigned hereby certifies to the Prune Marketing Committee and the United States Department of
Agriculture that the prunes described in the above affidavit were sold by the undersigned to the above named
diverter pursuant to Prune Reserve/Surplus Tonnage Sales Agreement, Fonn PMC 4.2, No.

Dated

Signature

Title

Finn

INSTRUCTIONS:
The AFFIDAVIT OF DIVERSION must be signed by the person responsible for actually using the prunes described.
The tabulated infonnation on the AFFIDAVIT OF DIVERSION must describe the deliveries pursuant to contracts between the actual user
and the finn &om which he purchased.
The DIVERSION CERTIFICA1E must be filled out by the intermediate party between the actual diverter and the PRUNE MARKETING
COMMIlTEE.

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