No Form number Southeastern Potatoes Application for Certificate of Pri

OMSNo.0581-0178
No.
Southeastern
PotatoCommittee
Eastville,
VA 23347
Application
toMakeSpecialPurposeShipments
Pursuantto regulations
issuedunderMarketingOrderNo.953,theundersigned
requestspermission
toship
potatoesforthefollowing
purpose,exemptfromgrade,sizeandinspection
requirements:
Potatochipping

; Canning

; Freezing

; Other

~
CWT

Quantityto beshipped
Wherewillshipments
originate:
NamesandAddressesofprocessors:

I certifyto theSoutheastern
PotatoCommittee
andtotheSecretaryofAgriculture
thatanyshipments
madepursuant
heretowillbemadeandreportedin accordance
withtheapplicable
regulations
of MarketingOrderNo.953.

(Handler)

(Adaess)

(Aulhonzed
RepresentabVe)

{[Jafiij

ActionbySoutheastern
PotatoAdministrative
Committee
Approvalisherebygivenfortheshipments
specifiedabove.

Date

Certificate
ofPrivilegeNo.
Signature
(Authorized
Committee
Representative)

Notapproved(reason):
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