FV-171 Prune Form No. 2-Sec. 8e Cert. Processor or Reseller

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAM PRUNE FORM NO. 2 Prunes – Section 8e Certification of Processor or Reseller

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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

I certify to the U.S. Department of Agriculture (USDA) that I have acquired the manufacturing grade substandard prunes covered by this certification; that I will use or sell them for use only in manufacturing in which the prunes lose their form and identity as prunes as permitted by the Regulation Governing the Importation of Prunes (7 CFR 999.200); and that I am:

□ PROCESSOR (user of prunes for manufacturing) □ RESELLER (dealer in prunes for manufacturing)

1. DATE OF PURCHASE	2. PLACE OF PURCHASE (City and State)
3. NAME AND ADDRESS OF IMPORTER OR SELLER	4. USDA CERTIFICATION OF QUALITY AND CONDITION NUMBER

5. PRUNES ACQUIRED:

NUMBER OF CONTAINERS	TOTAL NET WEIGHT (pounds)

NAME OF FIRM:

ADDRESS:

SIGNATURE OF AUTHORIZED OFFICIAL

TITLE

DATE

FV-171 (Rev. 05/2014. Destroy previous editions.)

DISTRIBUTION: Original – Fruit and Vegetable Program, AMS, Washington, D.C. 20250; Copy – Retained by Importer; Copy – Retained by Purchaser