CAC-301 905-Citrus Grown in FL. Handler Loan & Transfer Form Siz

OMB No. 0581-0189

CITRUS ADMINISTRATIVE COMMITTEE

P.O. Box 24508

Lakeland, FL 33802-4508

Phone: (863) 682-3103

Fax: (863) 683-9563

Email: [email protected]

HANDLER LOAN AND TRANSFER FORM

SIZE 48 AND SMALLER RED GRAPEFRUIT

The Citrus Administrative Committee (Committee) regulation governs the loan and/or transfer of size 48 and smaller red grapefruit as regulated by a percentage of shipments. Each handler acquiring a loan or transfer of size 48 and/or 56 red grapefruit that are regulated by a percentage of shipments shall complete this form.

Handler Making Loan and/or Transfer

Handler Name:

Phone No.: (_____) __________________________ Fax No.: (_____) ____________________________

Handler Acquiring Loan and/or Transfer

Handler Name:

Phone No.: (_____) __________________________ Fax No.: (_____) ____________________________

1. Circle regulation week of loan and/or transfer:

12 13 14 15 16 17 18 19 20 21 22

2. Number of 4/5 bu. box (cartons) loaned: __________
   
   

3. Number of 4/5 bu. box (cartons) transferred: __________
   
   

4. Date of loan and/or transfer: ____________________________, 20___
   
   

5. Regulation Week loan and/or transfer will be repaid¹: _________________

¹There are no loans after the 21^st regulation week. ALL LOANS must be repaid by the end of the 22^nd Regulation Week.

Sign and fax this form to the Committee. Forward a copy to the handler making the loan and/or transfer, and retain a copy for your files. This form must be completed and received by the Committee no later than 12:00 noon on the Wednesday following the regulation week for this loan and/or transfer.

I (we) certify to the Committee and the Secretary of Agriculture that this fruit is shipped in accordance with the current Marketing Order regulations. I (we) realize that the making of a false statement, knowing it to be false is a violation of title 18, section 1001, of the United States Code, among other statutes, which provide for fine and imprisonment.

Acquiring Handler’s Name: _________________________ Signature: _________________________________

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.

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.

CAC Form 301 (Exp. X/XXXX) Destroy previous editions.