PMC 2.63 CA Dried Prunes Statement of Proposed Disposition of Und

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Fonn PMC 2.63
OMB 0581-0178

Date

TO:

PMC Approval Number:

Prune Marketing Committee
3841 N. Freeway Blvd., Suite 120
Sacramento, CA. 95834

The undersigned hereby certifies to the United State Department of Agriculture and to the Prune Marketing
Committee for himself/herself and for and on behalf of
has purchased

that the undersigned

(Handler)
pounds of undersized prunes on or about

and that said prunes, subject to approval by the Committee, will be shipped to
(Name & Address of Converter)

and used as
(Usage)

Firm or
Individual
Address

By
Title
IMPORT ANT NOTICE
The issuing of a falsecertificate,knowingit to be false, is a violationof Title 18, Section 1001of the United StatesCode, whichprovidesa
penalty of a fine of not more than $10,000 or imprisonmentof not morethan5 years or both.
This report is required by law (7 V.S.C. 608 (d), 7CFR §993.50 (e) and 7CFR §993.150 (e) (I) (ii».
FAILURE TO REPORT can result in a fine of not less than $50.00 or more than $5,000 for each such violation and each day during which
such violation continues shall be deemed a separate violation.
This information

is required to obtain authority from the Committee to dispose of undersized prunes and it will be used for that purpose.

According to the Paperwork Reduction Act of 1995, an agency may not oonduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0178. The time required to
romplete this infurmation collection is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection ofinfonnation.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender,
religion, age, disability, political beliefS, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program infonnation (Braille, large print, audiotape, etc.) should contact USDA's TARGET
Center at (202) 720-2600 (voice and TOD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW,
Washington. DC 20250-9410 or call (202) 720-5964 (voice and TOD). USDA is an equal opportunity provider and employer.