CMC-CONF Third-Party Confirmation of Receipt of Withheld Fruit

OMB No. 0581-New
Cranberry Marketing Committee
219A Main Street
Wareham, MA 02571
Phone: (508) 291-1510; Fax: (508) 291-1511
Website: www.usacranberries.com

Filing Date: __________________

THIRD-PARTY CONFIRMATION OF RECEIPT OF WITHHELD FRUIT
In accordance with the Cranberry Marketing Order (§929.57 Outlets for withheld cranberries), handlers of cranberries must
notify the Cranberry Marketing Committee of any cranberries that are withheld from handling by completing a separate form
titled “Handler Application for Outlets for Excess Fruit,” and receive committee approval for such diversion. Where such fruit
is received by a third party (such as approved charities, foreign customers of whole fruit in undeveloped markets, or institution
conducting cranberry research), handlers must submit this form – and have the recipient third party complete the “Transfer
Confirmation” section.
Handler Name: __________________________________________ Handler Contact No.: _____________________________
Business Address: ______________________________________________________________________________________
Contact Name: _________________________________________ Telephone No.: __________________________________
Email Address: ________________________________________ Project Name: ____________________________________
Project Type:

Charitable Institution

Research & Development
Nonhuman Food Use

Product Form:

Fresh Fruit

Processed Fruit

Noncompetitive Outlets
Other

Concentrate/Juice

How many equivalent barrels of withheld fruit will be utilized: __________

Documents provided to support this delivery

TRANSFER CONFIRMATION
Transferred to: ____________________________________________________________________________________
Address: _________________________________________________________________________________________
Quantity Transferred: ______________ Product Form:

Fresh Fruit

Processed Fruit

Concentrate/Juice

Name: _____________________________________

Title: ____________________________________________

Signature: __________________________________

Date: ____________________________________________

HANDLER CERTIFICATION
I, _____________________hereby certify to the CMC and the Secretary of Agriculture that this is a true and correct
record of information regarding the undersigned Handler for the current crop year, and that the undersigned handler has a
good faith intent to withhold cranberries in accord with the Marketing Order as described herein. I further certify that I
have the authority to make such representation on behalf of the undersigned handler.
Name: _________________________________________ Title: ____________________________________________
Signature: ______________________________________ Date: ____________________________________________

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-NEW. 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.

CMC-CONF (10/2017)

OMB No. 0581-New

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USDA is an equal opportunity provider, employer, and lender.

CMC-CONF (10/2017)