PMC 10.5 CA Dried Prunes Diverters Request for Transferable Prune

OMB No. 0581-0178

Send to: PRUNE MARKETING COMMITTEE

3840 Rosin Court, Suite 170

Sacramento, CA 95834

DIVERTER’S REQUEST FOR TRANSFERABLE PRUNE PLUM DIVERSION CERTIFICATES

1. CHECK ONLY ONE BOX BELOW: A, B, OR C. DO NOT CHECK MORE THAN ONE.

2. Prepare this form in Duplicate –send original to the Prune Marketing Committee (Committee). Keep a copy for your file.

Harvested Dry Tons Credited _______________________ Application Number Date: __________________

Unharvested Dry Tons Credited _____________________ Date: ___________________________________

Total Dry Tons Credited ___________________________________________________________________________

□ A. I hereby request that the total tonnage certified as diverted by me be applied exclusively to the reserve pool prunes delivered by my name as indicated below:

My Name and Address My Account No. My Handler’s Name

_________________________________ _________________ ________________________________

_________________________________ _________________ ________________________________

□ B. I hereby request that the total tonnage certified as diverted by me be applied in part to my own reserve pool prunes (as indicated below) and the balance transferred to another producer (also indicated below):

APPLY TO MY OWN RESERVE

My Name and Address My Account No. My Handler’s Name Tons to Apply

__________________________ ____________________ ____________________ ____________

__________________________ ____________________ ____________________ ____________

APPLY TO ANOTHER PRODUCER’S RESERVE

His Name and Address His Account No. His Handler’s Name Tons to Apply

__________________________ ____________________ ____________________ ____________

__________________________ ____________________ ____________________ ____________

□ C. I hereby request that the total tonnage certified as diverted by me be transferred to another Producer and applied to his reserve as indicated below:

His Name and Address His Account No. His Handler’s Name

_________________________________ _________________ ________________________________

_________________________________ _________________ ________________________________

I understand that the above producers have actual prunes placed in the 20___ crop year reserve pool for their account which will be released to salable tonnage to the extent of the salable percent times the diversion certificate weights set forth for their respective names, at such time as the certificates are tendered to the Committee properly endorsed by me, by the respective producers listed above, and their handlers.

___________________________________________

Name of Producer

___________________________________________

Authorized Signature and Title

INSTRUCTIONS: This form was mailed to all independent diversion applicants with the official results of their diversion. The purpose of the form was to enable the independent diverter to notify the Committee to whom the Diversion Certificate should be issued and which account number and handler would be receiving the Certificate. Independent producers, after filling out this form, are required to return it to the Committee before a Transferable Diversion Certificate can be issued.

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 0581-0178. 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.

PMC 10.5 (Rev. 10/2010. Destroy previous editions.)