FV-36 ID/E. OR. Onions Spec. Purpose Shipment Receiver Certifi

u.s. DEPARTMENT OF AGRICULTURE (USDA)
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAMS

OMB NO. 0581-0178
SPECIAL PURPOSE SHIPMENT
RECEIVER CERTIFICATION

Idaho-Eastem Oregon Onion Conmittee
PO Box 909
Parma, ID 83660
208-722-5111 Fax: 208-722-6582

If you plan to purchase onions grown in the Idaho-Eastern Oregon production area, which do not
meet fresh market requirements as stated in 7 CFR §958.328 and intend them for canning,
dehydrating, extracting, freezing, and/or pickling, you must complete and submit this Certificate to the
Idaho-Eastern Oregon Onion Committee office. No shipment of onions for canning, dehydrating,
extracting, freezing, and/or pickling may be received from the Idaho-Eastern Oregon production areas
unless this form is completed and returned.

CERTIFICATION STATEMENT:
I, the undersigned, hereby certify to USDA and to the Idaho-Eastern Oregon Onion Committee that all
onions received at the address below from the Idaho-Eastern Oregon production area will be used for
(check all that apply):

D Canning

D Dehydrating D Extracting D Freezing

D Pickling

I, further certify that none of these onions will be diverted to any fresh market outlet(s). In addition, I
agree to submit such documents and reports to the Committee that may be requested for its auditing
purposes. Falsification of information on this government document may result in a fine of not more
than $10,000 or imprisonment of not more than five (5) years, or both (18 U.S.C. 1001).
Signature

Name

Title

Date

Processor
I

Phone

I

Zip

I

Address
City

I

State

I

I

According to the Paperwork Reduction Act of 1995, an agency may not conduct 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 complete this information 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 of information.
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.
FV-36 (06/06)