CDGAC-3 925-CA Desert Grapes End of Season Shipment Rept.

Generic OMB Fruit Crops, Marketing Order Administration Branch

CDGAC-3 Shipment Report (925)(07-10)

Generic Fruit Crops (Mandatory)

OMB: 0581-0189

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OMB No. 0158-0189

CALIFORNIA DESERT GRAPE ADMINISTRATIVE COMMITTEE

82901 Bliss Avenue

Indio, CA 92201

Phone: (760) 342-4385

Fax: (760) 342-0485

E-Mail: [email protected]


END OF SEASON SHIPMENT REPORT


Handler Address City, State, Zip Code


Grower Address City, State, Zip Code


Reporting Period:

Date of First Shipment to Date of Last Shipment


Please list all grape shipments

Total Number of Lugs Shipped (Pounds)

Invoice

Number

Shipping

Date

Variety

Name

Destination

City, State

10 lbs

12 lbs

16 lbs

18 lbs

20 lbs






























































































































































































Totals







The undersigned declares under penalty of perjury that the foregoing is true and correct.



Handler Name Handler Signature Date


The making of a false statement or representation on this form, knowing it to be false, is a violation of Title 18, section 1001 of the United States Code, which provides for a penalty of a fine of $10,000 or imprisonment of not more than five years, or both. This report is required by law. (7 U.S.C. 608(d)) Failure to report can result in a fine of not less than $50 or more than $5,000 for each such violation, and each day during which such violation continues shall be deemed a separate violation.


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. A valid OMB control number for this information collection is 0581-0189. The time required to complete this information collection is estimated to average 30 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 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 the 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.

CDGAC-3 (Rev. 07/10. Destroy previous editions.)

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleOMB 0158-0189
Authorjvawter
File Modified0000-00-00
File Created2021-02-02

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