923-Sweet Cherries Shippers/Receivers Application for Sp

OMB No. 0581-0189

SPSC#____________

WASHINGTON CHERRY MARKETING COMMITTEE

105 S. 18^TH STREET, SUITE 205

YAKIMA, WA 98901-2149

TELEPHONE: (509) 453-4837

FAX: (509) 453-4880

SHIPPERS/RECEIVERS APPLICATION FOR

SPECIAL PURPOSE SHIPMENT CERTIFICATE

I request permission to  ship or  receive (please check applicable box) sweet cherries from the Marketing Order No. 923 production area (counties in the State of Washington lying east of the Cascade Range) for grading and packing.

In consideration of your granting this permission, I agree to the following stipulations:

1. That I will provide a Special Purpose Shipment Report (SPSR) at close of business every Friday. I will prepare a SPSR on forms furnished by the Washington Cherry Marketing Committee (Committee). One copy will be mailed to the Committee, one copy will be mailed to the local state department of agriculture commodity inspection division, and one copy will be retained for my files. Failure to return the SPSR within 7 business days will result in cancellation of this Special Purpose Shipment Certificate.

2. I certify to the Committee, the U.S. Department of Agriculture, and Washington State Department of Agriculture that any shipments made pursuant to this Special Purpose Shipment Certificate will be made in accordance with the current regulations under Marketing Order No. 923, Chapter 16-414 WAC, Cherries, Chapter 16-461 WAC, Inspection Requirements for Fruit and Vegetables, and Chapter 16-463 WAC, Prohibiting the Sale and/or Movement of Infested Cherries. I have read these regulations and made this application with full knowledge thereof. Further, I agree to forward assessments due on these cherries to the Committee office.

Name _______________________________________ Signature __________________________________

Address _______________________________________ Date ______________________________________

(Street)

________________________________________ Telephone _________________________________

(City, State, and Zip Code)

*********************************************************************************************

ACTION BY THE WASHINGTON CHERRY MARKETING COMMITTEE

Permission is hereby granted/denied to the above shipper/receiver to ship sweet cherries under the Special Purpose Shipments provision under Marketing Order No. 923.

Manager __________________________________ 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 OMB 0581- 0189. The time required to complete this information collection is estimated to average 20 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.

(Exp. X/XXXX) Destroy previous editions.