FV-210 915-Avocados Producer Exemption

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAM	APPLICATION TO THE AVOCADO ADMINISTRATIVE COMMITTEE FOR PRODUCERS EXEMPTION CERTIFICATE			Avocado Administrative Committee P.O Box 900188 Homestead, FL 33090-0848 Tel: (305) 247-0848
DATE	NUMBER OF FRUIT IN SAMPLE
PRODUCER’S NAME				TEL. NUMBER (include area code)
MAILING ADDRESS (City, County, State, and Zip Code)
LOCATION OF GROVE (from established landmarks)
VARIETY FOR WHICH EXEMPTION IS REQUESTED □ Details □ Current Regulation □ Requested Exemption
SHIPPING DATE	WEIGHT			SIZE
HANDLER’S NAME
PRODUCER’S REASON FOR REQUESTING THIS EXEMPTION (If additional space is required, use back)
ESTIMATED QUANTITY OF AVOCADOS FOR WHICH EXEMPTION IS REQUESTED
CERTIFICATION OF STATEMENT: I (we) hereby agree to comply with all of the requirements of the Marketing Order regulating the handling of avocados grown in the Florida production area and with all the rules and regulations issued thereunder.
SIGNATURE OF APPLICANT				DATE
DO NOT WRITE BELOW THIS LINE
COMMITTEE ACTION
MATURITY SUBCOMMITTEE	YES	NO	AVOCADO ADMINISTRATIVE COMMITTEE		YES	NO

According 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 display s 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 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, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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.

FV-210 (Rev. 9/13. Destroy previous editions.)