OMB No. 0581-0189
CITRUS ADMINISTRATIVE COMMITTEE
P.O. Box 24508
Lakeland, FL 33802-4508
Phone: (863) 682-3103
Email: [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:
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.
Legal
description of my grove(s):
Variety
of citrus produced on the above listed grove(s):
Approximate
number of boxes produced on the above identified grove(s):
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.
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.
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 401 (Exp. X/XXXX) Destroy previous editions.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | CAC Form 301 |
Author | Arthur B. Chadwell |
File Modified | 0000-00-00 |
File Created | 2022-09-15 |