CDAC-9 (987) CA Dates--Producer Application for Exemption from

OMB No. 0581-0178

Send original and one copy to:

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

P.O. Box 1736

Indio, CA 92202-1736

Tel: (760) 347-4510 Fax: (760) 347-6374

PRODUCER APPLICATION FOR EXEMPTION FROM REGULATION

An application is made herewith to sell dates of my own production directly to consumers through: (1) Roadside Stand or Date Shop owned or operated by myself within 25 miles of Indio; (2) by Mail Order and Parcel Post or Express shipment; or (3) sold at California Certified Farmers Markets, or any combination of the three, and to have such exempt from the requirement of inspection and certification, withholding of restricted dates, container regulations, and assessments for expenses (§§ 987.41, 987.45, 987.48, 987.72 of Marketing Order No. 987).

In consideration of approval of this application, the undersigned agrees to sell the named outlets only dates meeting the modified U.S. Grade B or better requirements for domestic sale. The undersigned further agrees at the end of each crop year, but not later than October 10, to report to the California Date Administrative Committee (Committee) on form CDAC-2, the variety and quantity of dates sold under exemption.

Name of Producer: _____________________________________________________________________________

Address: _____________________________________________________________________________________

Street City State Zip Code

Date variety(ies) to be exempted: __________________________________________________________________

1. If sales are to be from Roadside Stand or Date Shop, indicate:

a. Location of shop and description: _________________________________________________________

b. Estimated total sales (in pounds): _________________________________________________________

2. If dates are to be sold by Mail Order and shipped direct to consumers, indicate:

a. Estimated total sales (in pounds): _________________________________________________________

3. If dates are to be sold at California Certified Farmers Markets, indicate:

a. Estimated total sales (in pounds): _________________________________________________________

I hereby certify to the U.S. Department of Agriculture and the CDAC that the agreement as to sales and reporting is accepted and that the information submitted herein is complete and accurate.

Signature: ___________________________________ Title: ______________________________________

Print Name: __________________________________ Date: ______________________________________

(Please enclose a copy of your certified producer certificate to verify eligibility)

The making of false statement or representation on this form, knowing it to be false, is a violation of title 18, section 1000 of the United States Code, which provides for the penalty of a fine or imprisonment, or both. This report is required by law (7 USC 608(d), 7CFR 987.51, 987.151). Failure to report can result in a fine for each violation and each day during which such violation continues shall be deemed a separate violation.

Approved for crop year ending September 30, 20___, but subject to revocation for cause, (1) the exemption from inspection and certification or (2) all the exemptions granted hereunder.

CALIFORNIA DATE ADMINISTRATIVE COMMITTEE

By: _________________________________________________ Date: _______________________________

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 0581-0178. The time required to complete this information collection is estimated to average 30 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.

CDAC-9 (Exp. x/xxxx) Destroy previous editions.