927-Handler Statement of Fresh Pear Shipment

OMB 0581-0189

FRESH PEAR COMMITTEE

4382 SE International Way, Suite A

Milwaukie, OR 97222-4635

Phone: (503) 652-9720

Fax: (503) 652-9721

HANDLER STATEMENT OF FRESH PEAR SHIPMENTS

20___ - 20___ SEASON

Submission of this statement and payment of assessments is mandatory and required by Marketing Order No. 927. Refer to the regulations for late charges and interest penalties that apply after 45 days. Please furnish this statement to the Control Committee every other Friday beginning on _____________________, 20___, covering all fresh pear varieties shipped interstate, intrastate or exported.

ENCLOSED FIND A CHECK / MONEY ORDER FOR $ ________________ COVERING:

_______ WINTER PEARS - STANDARD BOX EQUIVALENT (44 POUNDS) @ $.___ PER STD BOX

Winter Pear varieties include, but are not limited to, Anjou, Bosc, Comice, Nelis, Seckel, Forelle, Packham, Taylor's Gold, Concorde, Red Anjou, Rubaiyat, Red Angelo, Red Comice, Regal Red, Crimson Gem, Red Silk, Red Satin, California, Cascade, etc.

_______ SUMMER/FALL PEARS - STANDARD BOX EQUIVALENT (44 POUNDS) @ $.___ PER STD BOX

Summer/Fall Pear varieties include, but are not limited to, Bartlett, Red Bartlett, Red Sensation, Red Max, Starkrimson, Red Blush, Red Crimson, Crimson Red, Rosi Red, Red Gold, Canal, Red Early, Tosca etc.

THIS REPORT IS FOR THE TWO-WEEK PERIOD FROM ___________________, 20___ TO ___________________, 20___. (REPORTING PERIODS LISTED ON BACK)

DATE SHIPPED	STANDARD BOXES EQUIV.	VARIETY	ULTIMATE DESTINATION – NOT GATEWAY (CITY & STATE or CITY& COUNTRY)
TOTAL:

If shipped in bulk or in any container other than an equivalent standard container, 44 pounds is equivalent to one standard box.

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Signature Name of Handler

_________________________________________ __________________________________________

Date Address of Handler

Reporting Periods for Handler Statement of Fresh Pear Shipments

Report shipments made before the close of business every other Friday. (Include all shipments made prior to that date, not already reported in a previous report.)

20___ - 20___ Season

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Contact the Fresh Pear Committee for additional forms. Photocopies are also permissible. If computer printouts are used to report shipments and destination cities, then use this form to summarize boxes paid and the amount of assessments paid with the enclosed check. Make assessment checks payable to “Fresh Pear Committee” for all fresh pears, and enclose with the report of shipments. Mail to the Fresh Pear Committee at the address on page 1 of this form.

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 45 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, audio tape, 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, SW, Washington, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Rev. 07/10. Destroy previous editions.