FTC-108 Florida Tomatoes Application for Certificate of Privileg

OMB No. 0581-0178

FLORIDA TOMATO COMMITTEE Registered Handler No._________

800 Trafalgar Court, Suite 300  Maitland, FL 32751

Phone (407) 660-1949  Fax (407) 660-1656

www.floridatomatoes.org

20___ - 20___ APPLICATION FOR CERTIFICATE OF PRIVILEGE

Information given in this form is for the use of the Florida Tomato Committee, acting under the authority of the Secretary of Agriculture of the United States (Secretary). Section 966.54 of Marketing Order No. 966 requires that handlers desiring to make shipments of tomatoes for relief, charity, processing, or such other purposes, which may be specified by the Committee, with the approval of the Secretary, shall, prior to making such shipment, apply to the Committee for a Certificate of Privilege. The purpose of such certificate is to safeguard against the entry of such tomatoes into trade channels other than those for which this Certificate of Privilege is granted. REPORTS ON EACH SHIPMENT MUST BE MADE TO THE COMMITTEE ON THE SHIPPING DATE ON FORM FTC-110, REPORT OF SPECIAL PURPOSE SHIPMENT UNDER CERTIFICATE OF PRIVILEGE.

RECEIVERS MUST RETURN THE BLUE COPY TO THE COMMITTEE WITHIN TEN (10) DAYS AFTER RECEIPT. FAILURE TO DO SO MAY RESULT IN THE REVOCATION OF YOUR CERTIFICATE OF PRIVILEGE.

Name of Applicant ________________________________________________________________________

Address _________________________________________________________________________________

Purpose of shipment for which Certificate of Privilege is requested ____________________________________

________________________________________________________________________________________

Is the applicant registered as a tomato handler with the Committee? □ Yes □ No

If yes, please give Registration No. _____________________________________

To the best of my knowledge and belief, all statements contained in this application are true, correct and complete.

___________________________ ______________________________________________________

Date Name of Firm

__________________________ ______________________________________________________

Telephone Number Signature of Applicant

__________________________ ________________________________________________________

Fax Number Email address

DO NOT WRITE BELOW THIS LINE

Approved □ Disapproved □ Date __________________________________________________

Signature of Manager of 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 0581-0178. 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.

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CERTIFICATE OF PRIVILEGE

This is to certify that ________________________________________________________________________

Mailing Address ____________________________________________________________________________

has complied with the provisions of § 966.54 of the Marketing Agreement and Order regulating the shipment of Florida tomatoes and is authorized to ship tomatoes for the following purpose:

________________________________________________________________________________________

_______________________________________________________________________________________

during the period beginning OCTOBER 10, 20___ and ending JUNE 15, 20___.

All shipments must be certified by the Federal-State Inspection Service and shipping containers must be properly marked.

FLORIDA TOMATO COMMITTEE

________________________________________________

Florida Tomato Committee Manager

FTC-108 (Rev. 01/2014. Destroy previous editions.)