CAC 401 905 Citrus Grown in FL Grower Tree Run Certificate Appli

OMB No. 0581-0189

CITRUS ADMINISTRATIVE COMMITTEE
PO Box 941058
Maitland, FL 32794
Phone: (321)-214-5252 or (407) 765-5940
[email protected]
APPLICATION FOR A GROWER TREE RUN CERTIFICATE
20___ - 20___ SEASON
Name of Grower ______________________________________________________________________________
Address (incl. City, State, Zip Code __________________________________________________________________
____________________________________________________________________________________________
Phone No. (_____) ___________________________

Fax No. (_____) ___________________________

E-mail Address _______________________________________________________________________________
Hereby certifies and agrees to the following:
1. All citrus fruit handled by me will be from my grove(s), and is subject to Florida statute chapter 601.9911
and 7 CFR 301.75.
2. Legal description of my grove(s): __________________________________________________________
_____________________________________________________________________________________
3.

Variety of citrus produced on the above listed grove(s): _________________________________________

4.

Approximate number of boxes produced on the above identified grove(s): __________________________

5.

All citrus fruit handled by me will be reported to the Citrus Administrative Committee as required in 7 CFR
905.149, Reports of Shipments under Grower Tree Run Certificate.

6.

Each container must be identified by name and address, and any other information required by 7 CFR
301.75.

________________________________________________________
Grower Signature

____________________________
Date

False certification or knowingly making any false statement to the Secretary of Agriculture is a violation of title 18,
section 1001, of the United States Code, and is punishable by fine, imprisonment, or both.
The above application for a Grower Certificate is hereby approved/disapproved (circle one) for the period through
July 31, 20___. For the 20___ - 20___ season, you will be Grower Tree Run Certificate No. ________________.
________________________________________________________
Manager, Citrus Administrative Committee

____________________________
Date

FAILURE TO COMPLY WITH ANY OF THE CONDITIONS STATED IN THIS DOCUMENT IS
GROUNDS FOR IMMEDIATE TERMINATION OF THIS CERTIFICATE OF PRIVILEGE.
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 OMB
0581-0189. 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.

CAC Form 401 (Rev. 12/2018. Destroy previous editions.)

OMB No. 0581-0189

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its
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CAC Form 401 (Rev. 12/2018. Destroy previous editions.)