FV-170 Prune Form No. 1

REPRODUCE LOCALLY. Include form number and date on all reproductions.
U.S. DEPARTMENT OF AGRICULTURE
Agricultural Marketing Service
Fruit and Vegetable Programs

PRUNE FORM NO. 2

Prunes - Section 8e Certification
of Processor or Reseller

FORM APPROVED - OMB NO. 0581-0178

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 5
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.

I hereby certify to the U.S. Department of Agriculture that I have acquired the manufacturing grade substandard prunes covered by this
certification: that I will use or sell them for use only in manufacturing in which the prunes lose their form and identity as prunes as permitted
by the Regulation Governing the Importation of Prunes (7 CFR 999.200); and that I am (check one or both if applicable):
PROCESSOR (user of prunes for manufacturing)

RESELLER (dealer in prunes for manufacturing)

1. DATE OF PURCHASE

2. PLACE OF PURCHASE (City and State)

3. NAME AND ADDRESS OF IMPORTER OR SELLER

4. USDA CERTIFICATION OF QUALITY AND CONDITION NUMBER

5. PRUNES ACQUIRED:
NUMBER OF CONTAINERS

TOTAL NET WEIGHT (lbs.)

NAME OF FIRM

ADDRESS

SIGNATURE OF AUTHORIZED OFFICIAL

FV-171

TITLE

(09-07) (Destroy previous editions)

DISTRIBUTION: ORIGINAL - FRUIT AND VEGETABLE PROGRAMS, AMS Washington, D.C. 20250; Copy - Retained by Importer; Copy - Retained by Purchaser

DATE