CMC-CONF Third Party Confirmation

Fruit Crops

3rd Party Confirmation Receipt - CONF

OMB: 0581-0189

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OMB Control #: 0581-0189 CMC Form: CONF




THIRD-PARTY CONFIRMATION OF RECEIPT OF EXCESS FRUIT


Shape1 Shape2 Shape3 Shape4 Shape5 Shape6 Shape7 Shape8 Shape9 In accordance with the Cranberry Marketing Order (CMO) (§929.57 Outlets for excess 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 Contract #:

Address:

Contact Name: Phone: Email: Project Name: Project Type: Charitable Institution Research & Development Noncompetitive Outlets Nonhuman Food Use Other Product Form: Fresh Fruit Processed Fruit Concentrate/Juice

How many equivalent barrels of excess 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:


Shape10 Shape11 Shape12 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 0581-0189. The time required to complete this information collection is estimated to average 20 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.


The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).


To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or

(202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

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