SC-210 915-Avocados Producer Exemption

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE SPECIALTY CROPS PROGRAM	APPLICATION TO THE AVOCADO ADMINISTRATIVE COMMITTEE FOR PRODUCERS EXEMPTION CERTIFICATE			Avocado Administrative Committee P.O. Box 900188 Homestead, FL 33090-0848 Tel: (305) 247-0848
DATE	NUMBER OF FRUIT IN SAMPLE
PRODUCER’S NAME				TEL. NUMBER (include area code)
MAILING ADDRESS (City, County, State, and Zip Code)				EMAIL ADDRESS
LOCATION OF GROVE (from established landmarks)
VARIETY FOR WHICH EXEMPTION IS REQUESTED □ Details □ Current Regulation □ Requested Exemption
SHIPPING DATE	WEIGHT			SIZE
HANDLER’S NAME
PRODUCER’S REASON FOR REQUESTING THIS EXEMPTION (If additional space is required, use back)
ESTIMATED QUANTITY OF AVOCADOS FOR WHICH EXEMPTION IS REQUESTED
CERTIFICATION OF STATEMENT: I (we) hereby agree to comply with all of the requirements of the Marketing Order regulating the handling of avocados grown in the Florida production area and with all the rules and regulations issued thereunder.
SIGNATURE OF APPLICANT				DATE
DO NOT WRITE BELOW THIS LINE
COMMITTEE ACTION
MATURITY SUBCOMMITTEE	YES	NO	AVOCADO ADMINISTRATIVE COMMITTEE		YES	NO

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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.

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SC-210 (Exp. X/XXXX) Destroy previous editions.