SC-210-1 915-Avocados Certificate of Exemption

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

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

AVOCADO ADMINISTRATIVE COMMITTEE

CERTIFICATE OF EXEMPTION

Pursuant to the Marketing Order regulating the handling of avocados grown in South Florida, and upon the basis of the evidence submitted to, and the determination made by, the Avocado Administrative Committee (Committee), as provided in said Marketing Order, there is hereby granted to _______________________________, a producer of avocados, an exemption from the regulation issued pursuant to said authority regulating maturity which will permit said producer to ship or handle the avocados herein specified:

Variety			Size			Weight
Quantity			Not to be shipped before
Location of Grove

This Certificate of Exemption may be transferred by said producer to any purchaser of said fruit, and the benefits of this Exemption shall be applicable to such purchases, provided that such purchaser gives notice to the Committee of such transfer, including number and sizes of packages involved, prior to the time that the fruit covered herein is shipped, and provided further that this Certificate has been properly completed by the producer and signed before a commissioned notary public. This Certificate shall be surrendered to the Federal State Inspection Program for cancellation upon completion of inspection of the subject avocados.

Issued on ____________________ 20____ upon the direction of the Committee.

____________________________________ ______________________

Committee Administrator Date

All avocados offered pursuant to this Certificate of Exemption conform to the above specifications and were produced in the location shown above. This exemption is hereby transferred to ________________________________________________ (Name of Handler), whose address is __________________________________________________________________________________.

_____________________________________________

Signature of Avocado Grower

State of Florida; County of ____________________________

Before me, the undersigned authority, personally appeared ___________________________________, who, being duly sworn, states that he(she) is ____________________________________ (Name of Handler) of _________________________________ (Name of Firm or Corporation), and that the statements herein contained are correct to the best of his(her) knowledge and belief.

SEAL

__________________________________

Notary Public

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: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

SC-210-1 (Rev. 9/2016. Destroy previous editions.)