PMC 10.1-A PMC Application for Prune Plum Diversion Independent Pro

OMB No. 0581-0178

APPLICATION FOR PRUNE PLUM DIVERSION

INDEPENDENT PRODUCER

To: PRUNE MARKETING COMMITTEE 1. Date: _____________________

3840 Rosin Court, Suite 170

Sacramento, CA 95834

The undersigned hereby certifies that all information contained in this application is true and correct to his best knowledge and belief and that he held proprietary interest in the prune plums for diversion as of July 1, 20__.

FOR PMC USE ONLY
A. Producer Number
B. Application Approved
C. Field Office
Telephone Number

2. Name of Producer: ______________________________

_____________________________________________

3. Address: ______________________________________

_____________________________________________

4. Producer Status (check one): (1) Owner Operator □

(2) Share Landlord □

(3) Share Tenant □

(4) Cash Tenant □

DIVERSION
5. Maximum Green Tons Applied for		HARVESTED	UNHARVESTED	TOTAL
6. County(ies) of Production
7. Variety(ies) of Prune Plums
8. Location of Diversion	Dump Location		Orchard Location
9. Diversion Deposit: If Line 5 Total is 28.5 Green Tons or less the minimum deposit is $100 OR If Line 5 Total is greater than 28.5 Green Tons: (_____) x $3.50………………………………				$

FOR PMC USE ONLY DEPOSIT
D. Amount Received
E. Check Number
F. Date Received
G. Bank Number
H. Account Number
I. Signatory______________

10. Orchard Operator’s Name: ________________________________

(IF DIFFERENT THAN LINE 2)

11. Applicant’s Name: ______________________________________

(PLEASE PRINT)

12. Applicant’s Address: _____________________________________

______________________________________________________

13. Applicant’s Signature: ___________________________________

14. Telephone Number: _____________________________________

(AREA CODE AND NUMBER)

15. Mail to the Prune Marketing Committee (Committee) at the address above.

INSTRUCTIONS - INDEPENDENT PRODUCER

A. Study the example before filling out your application on the reserve side of this sheet.

B. Do not write anything in the block marked “For PMC Use Only.”

C. Be sure the application is otherwise 'completed in full to avoid rejection.

D. If you are a dehydrator or green fruit buyer acting as a diversion agent for one or more producers, please contact the Committee/Sacramento for special instructions in filling out your application (s).

E. The following instructions are numbered to correspond to the line numbers on the application.

1. Fill in the data on which the application is filled out.

2. The producer’s name on line 2 should be the same as the applicant on line 11, UNLESS the producer is a partnership or a corporation, or is doing business as an entity not in the name of the applicant. If the name is not the same as that shown on line 2, applicant should enter on line 11, after his name, his position (partner, manager, executor, president, owner, or other title best describing authority to make application).

3. Address of 2.

4. On line 4, check the box that applies to the status of the producer named on line 2. For example, if the name on line 2 is the Share Landlord, check box no. 2 on line 4, and if you as the applicant are the Share Tenant on the property, enter “Share Tenant” on line 11 after your name.

5. On line 5, enter in each box the green tons you intend to divert (not dried equivalent). If you intend to divert only HARVESTED (Dipper), enter the green tons applied for in the “Harvested” box, enter NONE in the “Unharvested” box, and repeat the figure entered in the “Harvested” box in the “TOTAL” box. If you intend to divert both harvested and unharvested, enter in the appropriate box the green tons to be diverted by each method, and show the total in the “TOTAL” box.

6. The county(ies) in which the prune plums for diversion were actually produced.

7. The variety(ies) of prune plums to be diverted. If interplant’s, enter the predominant varieties and the percentage of each variety.

8. The physical location where diversion will take place. Provide sufficient instructions to allow Committee representatives to locate the diversion location.

9. The amount on line 9 will be at least $100. If you are applying for more than 28.5 tons multiply the total tons applied for by $3.50, and enter this amount on line 9.

10. Print the title and name of the person to be contacted at the diversion location if not applicant.

11. See No. 4 above.

12. Mailing address to which applicant wants diversion information sent if different from line 3 above.

13. Signature of person qualified to authorize diversion.

14. Telephone number at which you can be reached to answer a question on your diversion during the day. If you are there during certain hours of the day so indicate, for example (916) 123-4567 (12:00 -1:00 p.m.).

15. Mail application to this address. If you have questions on the information required on the balance of the application form, call (916) 565-6235, or write to the address shown on line 15 of the application.

IMPORTANT NOTICE: The issuance of a false certificate knowing it to be false is a violation of title 18, section 1001 of the United States Code, which provides a penalty of a fine or imprisonment, or both.

AUTHORITY: § 993.62 of Marketing Order No. 993, as amended, and § 993. 162(c) of the Administrative Rules and Regulations established pursuant thereto.

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 10 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 10.1A (Rev. 10/2010. Destroy previous editions.)