FV-217 915-Avocados Application for Registered Processor

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAMS	APPLICATION FOR REGISTRATION AS AVOCADO PROCESSOR			Avocado Administrative Committee P.O. Box 900188 Homestead, FL 33090-0188 Tel: (305) 247-0848
Any person who desires to buy, as an approved manufacturer of avocado products, avocados for commercial processing, shall, prior thereto, submit to the Avocado Administrative Committee an application containing the following information (7 CFR § 915.141):
NAME OF APPLICANT
MAILING ADDRESS (City, County, State, and Zip Code)
REGISTERED AVOCADO HANDLER’S NUMBER		LOCATION OF PROCESSING FACILITIES
TYPE OF PRODUCT OR PRODUCTS TO BE MADE OR DERIVED FROM AVOCADOS
DESCRIPTION OF FACILITIES FOR PROCESSING AVOCADOS
STATE QUANTITY OF AVOCADOS PROCESSED DURING THE PREVIOUS YEAR		ESTIMATED QUANTITY OF AVOCADOS TO BE PROCESSED DURING THE CURRENT YEAR
FROM WHAT SOURCE DO YOU EXPECT TO RECEIVE AVOCADOS FOR PROCESSING?
HOW WILL THE AVOCADOS BE TRANSPORTED
WHERE WILL THE UNLOAD POINT BE?
CERTIFICATION STATEMENT: I hereby state that all the avocados obtained for processing into products will be used for that purpose only and will not be resold or disposed of in fresh fruit channels, and I agree to report such reports as are required by the Avocado Administrative Committee.
NAME OF FIRM
SIGNATURE AND TITLE			DATE

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 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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV-217 (Rev. 7/10. Destroy previous editions.)