RAC-102 Export Raisin Back release Order

OMB No. 0581-0178

RAISIN ADMINISTRATIVE COMMITTEE Release No.: ____________________________

2445 Capitol Street, Suite 200 Date: _____________________

Fresno, California 93721

Phone: (559) 225-0520

EXPORT RAISIN BACK RELEASE ORDER

Source: _________________________________

To: ___________________________________

You are authorized to withdraw from the 20___ crop year reserve tonnage raisins in the quantities shown below:

WHEN SHIPMENT IS COMPLETED ONE COPY OF THIS RELEASE MUST BE SIGNED AND RETURNED TO THE RAC
Quantity (lbs.)	Description	Sales Invoice No.

Final acknowledgment of arrival and receipt of above raisins.		The above raisins have been shipped in the quantities indicated.
To:		Source:
(print packer name)
By:		By:
Date:		Date:
		Raisin Administrative Committee
		By:

This report is required by law (7 U.S.C. 608d, 7 CFR 989.67). Failure to report can result in a fine of $1,100 for each such violation, and each day during which such violation continues shall be deemed a separate violation.

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 3 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.

RAC-102 (Rev. 01/2014) Destroy previous editions.