CAC-301 905-Citrus Grown in FL. Admin. Regulation-Size 48 & Smal

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]

HANDLER LOAN AND TRANSFER FORM

SIZE 48 AND SMALLER RED GRAPEFRUIT

The Citrus Administrative Committee (Committee) regulation governs the loan and/or transfer of size 48 and smaller red grapefruit as regulated by a percentage of shipments. Each handler acquiring a loan or transfer of size 48 and/or 56 red grapefruit that are regulated by a percentage of shipments shall complete this form.

Handler Making Loan and/or Transfer

Handler Name:

Phone No.: (_____) __________________________ Fax No.: (_____) ___________________________

Handler Acquiring Loan and/or Transfer

Handler Name:

Phone No.: (_____) __________________________ Fax No.: (_____) ___________________________

1. Circle regulation week of loan and/or transfer:

12 13 14 15 16 17 18 19 20 21 22

2. Number of 4/5 bu. box (cartons) loaned: __________

3. Number of 4/5 bu. box (cartons) transferred: __________

4. Date of loan and/or transfer: ____________________________, 20___

5. Regulation Week loan and/or transfer will be repaid¹: _________________

¹There are no loans after the 21^st regulation week. ALL LOANS must be repaid by the end of the 22^nd Regulation Week.

Sign and fax this form to the Committee. Forward a copy to the handler making the loan and/or transfer, and retain a copy for your files. This form must be completed and received by the Committee no later than 12:00 noon on the Wednesday following the regulation week for this loan and/or transfer.

I (we) certify to the Committee and the Secretary of Agriculture that this fruit is shipped in accordance with the current Marketing Order regulations. 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.

Acquiring Handler’s Name: _________________________ Signature: _________________________________

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 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 301 (Rev. 7/10. Destroy previous editions.)