PMC 10.5 (993) CA Dried Prunes Diverters Request for Transferable

OMB No. 0581-0178

Send to: PRUNE MARKETING COMMITTEE

3840 Rosin Court, Suite 170

Sacramento, CA 95834

DIVERTER’S REQUEST FOR TRANSFERABLE PRUNE PLUM DIVERSION CERTIFICATES

1. CHECK ONLY ONE BOX BELOW: A, B, OR C. DO NOT CHECK MORE THAN ONE.

2. Prepare this form in Duplicate –send original to the Prune Marketing Committee (Committee). Keep a copy for your file.

Harvested Dry Tons Credited _______________________ Application Number Date: __________________

Unharvested Dry Tons Credited _____________________ Date: ___________________________________

Total Dry Tons Credited ___________________________________________________________________________

□ A. I hereby request that the total tonnage certified as diverted by me be applied exclusively to the reserve pool prunes delivered by my name as indicated below:

My Name and Address My Account No. My Handler’s Name

_________________________________ _________________ ________________________________

_________________________________ _________________ ________________________________

□ B. I hereby request that the total tonnage certified as diverted by me be applied in part to my own reserve pool prunes (as indicated below) and the balance transferred to another producer (also indicated below):

APPLY TO MY OWN RESERVE

My Name and Address My Account No. My Handler’s Name Tons to Apply

__________________________ ____________________ ____________________ ____________

__________________________ ____________________ ____________________ ____________

APPLY TO ANOTHER PRODUCER’S RESERVE

His Name and Address His Account No. His Handler’s Name Tons to Apply

__________________________ ____________________ ____________________ ____________

__________________________ ____________________ ____________________ ____________

□ C. I hereby request that the total tonnage certified as diverted by me be transferred to another Producer and applied to his reserve as indicated below:

His Name and Address His Account No. His Handler’s Name

_________________________________ _________________ ________________________________

_________________________________ _________________ ________________________________

I understand that the above producers have actual prunes placed in the 20___ crop year reserve pool for their account which will be released to salable tonnage to the extent of the salable percent times the diversion certificate weights set forth for their respective names, at such time as the certificates are tendered to the Committee properly endorsed by me, by the respective producers listed above, and their handlers.

___________________________________________

Name of Producer

___________________________________________

Authorized Signature and Title

INSTRUCTIONS: This form was mailed to all independent diversion applicants with the official results of their diversion. The purpose of the form was to enable the independent diverter to notify the Committee to whom the Diversion Certificate should be issued and which account number and handler would be receiving the Certificate. Independent producers, after filling out this form, are required to return it to the Committee before a Transferable Diversion Certificate can be issued.

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.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

PMC 10.5 (Rev. 01/2017) Destroy previous editions.