927-Handler Statement of Fresh Pear Shipment

OMB No. 0581-0189

FRESH PEAR COMMITTEE Phone: (503) 652-9720

4382 SE International Way, Suite A Fax: (503) 652-9721

Milwaukie, OR 97222-4635

HANDLER STATEMENT OF FRESH PEAR SHIPMENTS

20___ - 20___ SEASON

Submission of this statement and payment of assessments is mandatory and required by Marketing Order No. 927. Refer to the regulations for late charges and interest penalties that apply after 45 days. Please furnish this statement to the Control Committee every other Friday beginning on _____________________, 20___, covering all fresh pear varieties shipped interstate, intrastate or exported.

ENCLOSED FIND A CHECK / MONEY ORDER FOR $ ________________ COVERING:

_______ WINTER PEARS - STANDARD BOX EQUIVALENT (44 POUNDS) @ $.___ PER STD BOX

Winter Pear varieties include, but are not limited to, Anjou, Bosc, Comice, Nelis, Seckel, Forelle, Packham, Taylor's Gold, Concorde, Red Anjou, Rubaiyat, Red Angelo, Red Comice, Regal Red, Crimson Gem, Red Silk, Red Satin, California, Cascade, etc.

_______ SUMMER/FALL PEARS - STANDARD BOX EQUIVALENT (44 POUNDS) @ $.___ PER STD BOX

Summer/Fall Pear varieties include, but are not limited to, Bartlett, Red Bartlett, Red Sensation, Red Max, Starkrimson, Red Blush, Red Crimson, Crimson Red, Rosi Red, Red Gold, Canal, Red Early, Tosca, etc.

THIS REPORT IS FOR THE TWO-WEEK PERIOD FROM ___________________, 20___ TO ___________________, 20___. (REPORTING PERIODS LISTED ON BACK)

DATE SHIPPED	STANDARD BOXES EQUIV.	VARIETY	ULTIMATE DESTINATION – NOT GATEWAY (CITY & STATE or CITY& COUNTRY)
TOTAL:

If shipped in bulk or in any container other than an equivalent standard container, 44 pounds is equivalent to one standard box.

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Signature Name of Handler

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Date Address of Handler

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 45 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.

Reporting Periods for Handler Statement of Fresh Pear Shipments

Report shipments made before the close of business every other Friday. (Include all shipments made prior to that date, not already reported in a previous report.)

20___ - 20___ Season

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Contact the Fresh Pear Committee for additional forms. Photocopies are also permissible. If computer printouts are used to report shipments and destination cities, then use this form to summarize boxes paid and the amount of assessments paid with the enclosed check. Make assessment checks payable to “Fresh Pear Committee” for all fresh pears, and enclose with the report of shipments. Mail to the Fresh Pear Committee at the address on page 1 of this form.

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.

Rev. 9/2016. Destroy previous editions.