CAC 110 905-FL. Citrus Report of Shipments under Certificate of

Generic OMB Fruit Crops, Marketing Order Administration Branch

CAC-110 Repacker Shipments Rept FL Citrus (905) (09-10)

Generic Fruit Crops (Mandatory)

OMB: 0581-0189

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OMB No. 0581-0189

CITRUS ADMINISTRATIVE COMMITTEE

P.O. Box 24508

Lakeland, FL 33802-4508

Phone: (863) 682-3103

Fax: (863) 683-9563

[email protected]


REPORT OF SHIPMENTS UNDER REPACKING CERTIFICATE OF PRIVILEGE

As required by Marketing Order No. 905, regulating the handling of

oranges, grapefruit, tangerines, and tangelos grown in Florida


Shipped to _____________________________________ Address ___________________________


Truck License No. ______________ Shipping Date ___________ Certificate No. ________________


Variety of Citrus Fruit

Number of Containers

Fruit Size

Type of Container

Size of Container

Manifest Number





































Total Containers







The undersigned certifies to the Committee and the Secretary of Agriculture that this citrus shipment is being shipped in accordance with current Marketing Order No. 905 Regulations for Repacking. I (we) realize that the making of a false statement, knowing it to be false, is a violation of Title 18, section 1001, of the United States Code, among other statutes, which provide for fine and imprisonment.


Repacking Shipper

Address

20___-20___ Season

Repacking Certificate of Privilege No. ________


Signature of Repacking Shipper ______________________________________


Instructions to Repacking Shipper: Complete this report for each repacked shipment. Sign all copies and mail the white copy to the Committee. The pink copy goes with the shipment. Retain the canary copy for your files. Give the goldenrod copy to the trucker.



NOTE: 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 0581-0189. The time required to complete this information collection is estimated to average 7 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.

CAC Form 110 (Rev. 7/10. Destroy previous editions.)

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCAC Form 110
AuthorCAC
File Modified0000-00-00
File Created2021-01-31

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