FV-170 Prune Form No. 1

REPRODUCE LOCALLY. Include form number and date on all reproductions.

FORM APPROVED - OMB NO. 0581-0178

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respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this
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U.S. DEPARTMENT OF AGRICULTURE
Agricultural Marketing Service
Fruit and Vegetable Programs

The 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, marital status, familial status, parental status, religion, sexual
orientation, genetic information, 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 communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center
at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights,
1400 Independence Avenue, S.W.,Washington,D.C.20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).
USDA is an equal opportunity provider and employer.

PRUNE FORM NO. 1
Prunes - Section 8e Entry Declaration

I cetify to the U.S. Department of Agriculture and the Bureau of Customs that none of the manufacturing grade substandard prunes being
imported and which are identified below will be used other than in manufacturing in which the prunes lose their form and identity as prunes.
1. NAME OF VESSEL

4. CITY OF ARRIVAL

2. COUNTRY OF ORIGIN OF PRUNES

5. UNLOADING PIER

3. DATE OF ARRIVAL

6. USDA CERTIFICATION OF QUALITY AND CONDITION NO.

7. SUBSTANDARD PRUNES ENTERED:
LOT OR CHOP MARK

NO. OF CONTAINERS

TOTAL NET WEIGHT (lbs.)

I agree to obtain from each person to whom any of the manufacturing grade substandard prunes listed uner item 7 are delivered, an
executed Prune Form No. 2 (Prunes-Section 8e Certification of Processor or Reseller) and to file the same with the Fruit and Vegetable
Programs, Agricultural Marketing Service, U.S. Department of Agriculture, Washington, D.C. 20250, not later than the 5th day of the
month following the month in which the prunes were delivered.
NAME OF FIRM

ADDRESS

SIGNATURE OF AUTHORIZED OFFICIAL

FV-170

TITLE

(09-07) (Destroy previous editions)

DISTRIBUTION: ORIGINAL - U.S. CUSTOMS SERVICE; COPY - FRUIT AND VEGETABLE PROGRAMS, AMS, Washington, D.C. 20250

DATE