PMC 10.13 CA Dried Prunes Withdrawal of Application for Prune Plum

OMB No. 0581-0178

Date: ___________________________

TO: PRUNE MARKETING Committee

3840 Rosin Court, Suite 170

Sacramento, CA 95834

The undersigned desires to withdraw his Application for Prune Plum Diversion of 20___ crop prunes and requests the Prune Marketing Committee (Committee) to cease any current action it may be taking pursuant to such application.

The undersigned hereby requests refund of any portion of his deposit that is subject to refund in accordance with applicable provisions of Marketing Order No. 993, as amended, and with the Administrative Rules and Procedures established pursuant thereto.

_______________________________________ _______________________________________

Name of Firm or Partnership Signature and Title

INSTRUCTIONS FOR THE WITHDRAWAL REQUEST: All applications wishing to withdraw tram the green diversion program must obtain a form PMC 10.13. The form is to be filled out and submitted to the Committee Sacramento office.

The Committee will process the Withdrawal Form and will correspond with the applicant within 10 days of receipt by the Sacramento office. The cost of withdrawal is $10.00 if no work has been performed in the field. If delineation and appraisal have been made there will be a withdrawal cost of $100.00. Harvested diversion applicants will have a withdrawal cost of $10.00 until the time the Supplement if filled out. If the Supplement has been filled out, but not physical destruction of prune plums has been made, the withdrawal will be $60.00. If harvested prune plums have actually been diverted, the withdrawal cost will be $100.00.

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 3 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 10.13 (Rev. 10/2010. Destroy previous editions.)