PMC 10.13 (993) CA Dried Prunes Withdrawal of Application for Prun

OMB No. 0581-0178

Date: ___________________________

TO: PRUNE MARKETING Committee

3840 Rosin Court, Suite 170

Sacramento, CA 95834

The undersigned desires to withdraw his Application for Prune Plum Diversion of 20___ crop prunes and requests the Prune Marketing Committee (Committee) to cease any current action it may be taking pursuant to such application.

The undersigned hereby requests refund of any portion of his deposit that is subject to refund in accordance with applicable provisions of Marketing Order No. 993, as amended, and with the Administrative Rules and Procedures established pursuant thereto.

_______________________________________ _______________________________________

Name of Firm or Partnership Signature and Title

INSTRUCTIONS FOR THE WITHDRAWAL REQUEST: All applications wishing to withdraw tram the green diversion program must obtain a form PMC 10.13. The form is to be filled out and submitted to the Committee Sacramento office.

The Committee will process the Withdrawal Form and will correspond with the applicant within 10 days of receipt by the Sacramento office. The cost of withdrawal is $10.00 if no work has been performed in the field. If delineation and appraisal have been made there will be a withdrawal cost of $100.00. Harvested diversion applicants will have a withdrawal cost of $10.00 until the time the Supplement if filled out. If the Supplement has been filled out, but not physical destruction of prune plums has been made, the withdrawal will be $60.00. If harvested prune plums have actually been diverted, the withdrawal cost will be $100.00.

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 3 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.

PMC 10.13 (Exp. x/xxxx) Destroy previous editions.