RAC-106 Application to Purchase Reserve Pool Raisins

OMB No. 0581-0178

RAISIN ADMINISTRATIVE COMMITTEE

2445 Capitol Street, Suite 200

Fresno, California 93721

Phone: (559) 225-0520

APPLICATION TO PURCHASE RESERVE POOL RAISINS TO FULFILL AN OFFER TO SELL

PURSUANT TO ANNOUNCEMENT FV-___

Contract No. ________________

The undersigned Packer hereby requests approval by the Raisin Administrative Committee (RAC) of this application. It is understood that upon approval of this application, the Packer has agreed to purchase, and the RAC has agreed to sell, the quantity of natural condition raisins specified herein for use in fulfilling the Packer’s accepted “Offer to Sell” pursuant to the U.S. Department of Agriculture’s Announcement FV- ________ Invitation __________.

Varietal Type	Net Pounds per Shipping Case	No. of Shipping Cases	Total Net Pounds Packed Weight	Factor per FV_____	Equiv. Natural Condition Weight = Packed Weight Divided by Factor:	Amount to be Invoiced at $_____ per ton ($._____ per lb.)
					Total

As a condition of RAC approval of this application and in conformance with section 989.73(d) of Marketing Order No. 989, the undersigned Packer agrees to furnish to the RAC one copy of the commercial bill of lading and one copy of the USDA Inspection Service’s Certificate of loading relative to each shipment of raisins from the tonnage released pursuant to this application.

Packer			FOR RAC USE ONLY
Address			Date Received
Title			Application No.
E-mail			Tonnage Approved
			Date Approved
Signature			By:

The making of any false statement or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001 of the United States Code, which provides for a penalty of a fine or imprisonment of not more than five years, or both.

This report is required by law (7 U.S.C. 608d, 7 CFR 989.167). 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 10 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-106 (Rev. 01/2014) Destroy previous editions.