CAC 303 (905) FL Citrus--New Handler Application

OMB No. 0581-0189

CITRUS ADMINISTRATIVE COMMITTEE

P.O. Box 24508

Lakeland, FL 33802-4508

Phone: (863) 682-3103

Fax: (863) 683-9563

Email: [email protected]

APPLICATION FOR NEW HANDLER OF RED GRAPEFRUIT

20___ - 20___ SEASON

Name of Registered Packinghouse

Address (incl. City, State, Zip Code)

Phone No. (_____) __________________________ Fax No. (_____) _________________________

Hereby certifies and agrees to the following:

1. I (we) have obtained a license as a Citrus Fruit Dealer, and request to be considered as a New Handler of Red Grapefruit from the date of this application to July 31, 20___.

(Citrus Fruit Dealer License Number _______________)

2. I (we) will have registered our packinghouse with the Florida Department of Agriculture, Division of Fruit & Vegetable for the 20___ - 20___ season. The Division of Fruit & Vegetable has assigned us a packinghouse Registration Number: ________________.

3. This season will be the first season in which we will ship red grapefruit at this location or under the Registration Number assigned to us by the Florida Department of Agriculture, Division of Fruit & Vegetable.

________________________________________ _______________________ _____________

Authorized Signature of Registered Packinghouse Title Date

False certification or knowingly making any false statement to the Secretary of Agriculture is a violation of title 18, section 1001, of the United States Code, and is punishable by fine, imprisonment, or both.

The above application for a New Handler of Red Grapefruit is hereby approved/disapproved (circle one) for the 20___ - 20___ Season.

By: __________________________________________________ Date: ________________

Manager, Citrus Administrative Committee

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 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.

CAC Form 303 (Rev. 9/13. Destroy previous editions.)