PMC 4.72B CA Dried Prunes--Foreign Export Notice of Usage of Subst

OMB No. 0581-0178

PRUNE MARKETING COMMITTEE PMC Approval No.:_______________

3840 Rosin Court, Suite 170

Sacramento, CA 95834

FOREIGN EXPORT NOTICE OF USAGE OF SUBSTANDARD PRUNES

FOR MANUFACTURING PURPOSES

NOTE: Do not complete or forward until this entire shipment of prunes has been used.

CERTIFICATION: The under signed hereby certifies to the United States Department of Agriculture and to the Prune Marketing Committee (Committee) that the following described shipment of dried substandard prunes has been used for the following manufacturing purpose: ___________________________________________

Date prunes were received: ______________________________________________________________

Net weight used: _______________________________________________________________________

Date usage was completed: ______________________________________________________________

Name and address of processing firm: ______________________________________________________

Name and address of purchasing firm: _____________________________________________________

Signed: __________________________ ____ Title: ___________________ Date: ______________

INSTRUCTIONS: Complete in triplicate immediately upon usage of the described dried substandard prunes. Return the original to the Committee. Return a copy to your supplier, and retain a copy for your records.

IMPORTANT NOTICE: This report is required by law (7 U.S.C. 608(d), 7CFR 993.50(e), 993.73 and 993.150(e)).

FAILURE TO REPORT can result in a fine for each such violation and each day during which such violation continues shall be deemed a separate violation. 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.

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 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 4.72B (Rev. 01/2014. Destroy previous editions.)