FV-197 Raisin Form No. 1

u

REPRODUCE

LOCALLY.

Include

form number

---

FORM APPROVED

and date on e/l reprrx!uctioM.
U." aEPARI1IEIII1'01' AGRICUL
1111II
AcRcuLTURAL MARKET1NG
SEIMCI!

-OMB NO. 0&81-0171

FRUIT AND VEGETABLE PROGRAMS

RAISIN FORM NO. 1

Raisins

- Section

8e Entry Declaration

~

thn IIIIYpemJn who vIoIlIta the provl:Jlom 01 SectIon 8.. mey 1Mfined not lea tIuJn
160 or fn9IfI th." 16,000 lor elIChsuch vIoIInIon. &ell"
thn such vIoJiItJDnt:t1tJtInue6."., be deemed . ..".,.",
violation. FeISII~tk1n
to IIIIIIflMCYof the
United StetN In any mattiii' within Its jurl$d/ctkJn,knowing It tDbe t./u, .. vIo/nkJn 01 1811.S.C. 1001 whkh plOvida for. It.- or /mpdsonment tI botII.
711.following stlItements..
made In IlCCtJIdMIcewith the PrIvacyAct of 1974 (6 use 662eJ.
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 OMBcontrol number. The valid OMScontrol number for this information collection is 0581-0178. The time required to
complete this Information collection Is estimated to average 15 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 an its programs and activities on the basis of race, color, nationai 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 (BraiDe, large print. audiotape, etc.) should contact USDA's TARGETCenter at (202) 720-2600
(voice and TOO). To file a complaint of discrimination, write to USDA,Director, Office of CivIlRights, 1400 Independence Avenue, S.W., Washington, D.C.
20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TOO). USDAis an equal opportunity provider and employer.

S«:tIon

Be (14J fA} of the Agt#t:uItunII Matlcet/ns1 Agreement

Act of 1937,

I HEREBY CERTD'Y to the U.S. Departmeat of Agriculture and the U.S. Customs Service that noDe of the raisins being imported and which are
idendfied below will be used otber than in the production of alcohol, syrup for iDdustria1use, raisin paste, or animal feed.
(Cluck DMor 1IUIf'fI1/
tq1JIllctJble.)
.

D

PRODUCTIONOF
ALCOHOL

D

PRODUCTION OF SYRUP FOR
INDUSTRIAL. USE

1. Type of carrier end number or name:

D
D

PRODUCTION OF ANIMAL FEED
PRODUCTION OF RAISIN PASTE

2. COUNTRYOF OfllG'r OF RAISINS

(RaIlroadcar, truck, ve888l, or other carrier, ,.Uroad car nwnber, truck tlg .
number, name of V888e1,or similar IdentiflcatIon)
3. e".TE OF ARRIVAL

4. PLACEOF ENTRY

15. PORT OF UJlLOADING AND UNLOADING PISI

15. USDA

CERTIFICATE

OF QUALI1Y

AND

CONDfTION

NUMBER

7. RAISINS ENTERED:
LOTOR CHOP MARK

NUMBER
OF CONTAiNERS

TOTALNETweiGHT
(PuuntbJ

LOT OR CHOPMARK

NUMBER
OF CONTAiNERS

TOTAL.NETWEIGHT
(Pound:l}

I AGREE to obtain.from each person to whom any of the raisins 1istedabove are delivered an exeatted Raisin Form No. 2, "lWsins - Section 8e
Certification of ProcesSor or Rese1Ier-, aDd to file the same with the Marketing Order Administration Branch, Fruit and Vegetable Programs,
AgriculturafMarketini Service, U.S. Departmentof Agriculture,Room 2S2S-SouthBuilding,P.O. Box 96456, Washington,DC 20090-6456not later
than the fifth day of the moad1followingthe mODtbin whichthe raisins were delivered.
DATI!

INAMEANDADCI\ESSOF ARM .

ISIGNATUREOF AUTHORIZEDOFROAL

TITLE

FV.197

10&-011CDeauoy.prevl_

ed1t/onal

D'8TRi8UTlO~:O,R!GINAL.
U.S.CUSTOMS
SERVICE:
COPY- FRUITANDVEGETABLE
PROGRAMS