AVO-IEF Declaration of Importer Eligibility

OMB No. 0581-0093

Hass Avocado Board

Declaration of Importer Eligibility

Notification

1. Section 1219.30(a) of the Hass Avocado Promotion, Research, and Information Order (Order) requires every board member and alternate to be domiciled in the United States. Domiciled means a place where a person has their true, fixed, and permanent home, and to which whenever they are absent they have the intention of returning. A person may have more than one residence but only one domicile. Black’s Law Dictionary (5^th Edition). No single document, fact or circumstance, is conclusive in determining United States domicile, and if a nominee, member, or alternate is uncertain of his or her domicile status, he or she should consult his or her attorney.

2. Section 1219.30(d) of the Order, defines an “Importer” as a “person who is involved in, as a substantial activity, the importation of Hass avocados for sale or marketing in the United States (either directly or as an agent, broker, or consignee of any person that produces Hass avocados outside of the United States for sale in the United States), who is subject to assessments under the Order, and who is listed by U.S. Customs as the importer of record for such Hass avocados. A substantial activity means that the volume of a person's Hass avocado imports must exceed the volume of the person’s production or handling of domestic Hass avocados. In addition, the term “person” (as defined in §1219.19 of the Order) means any individual, group of individuals, firm, partnership, corporation, joint stock company, association, cooperative, or any other legal entity.

3. Hass Avocado Board (HAB) members and alternates shall maintain the qualification requirements during their entire term on HAB. If a HAB member or alternate does not maintain the qualification requirements, then the member or alternate shall have 30 days to voluntarily resign in writing to HAB management. If after 30 days, the member or alternate refuses to resign, HAB management will request removal of the member or alternate by the U.S. Department of Agriculture (USDA) and the position shall automatically become vacant.

4. Current board members and alternates shall be required to complete and sign this form on an annual basis. Failure to complete and submit this form by the required date will result in automatic disqualification. HAB management will request removal of the member or alternate by USDA and the position shall automatically become vacant.

Declaration

I, _________________, hereby declare, under penalty of perjury, that (i) I am an Importer (as defined above) and (ii) I am domiciled in the United States. I further declare that I meet the qualifications of an Importer and that I reside in and maintain a place of abode at: ___________________________________ _____________________________(address/city/State/zip), which place of abode I recognize and intend to maintain as my permanent home and, if I maintain another place or places of abode in some other country or countries, I hereby declare that my above described residence and abode in the United States constitutes my predominant and principal home and I intend to continue it permanently as such.

_________________________________________ _________________________________________________ ____________________________

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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 0581-0093. The time required to complete this information collection is estimated to average 15 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 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.

AVO-IEF (Expiration Date XX/XX/20XX) See reverse for burden/non-discrimination statement