CAC Form 301

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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 21st regulation week.  ALL LOANS must be repaid by the end of the 22nd 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: _________________________________


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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.