SC-171 (993) Prune Form No. 2-Sec. 8e Cert. Processor or Resell

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0178

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

PRUNE FORM NO. 2

Prunes – Section 8e Certification of
Processor or Reseller

I certify to the U.S. Department of Agriculture (USDA) that I have acquired the manufacturing grade substandard prunes covered by this certification; that I will use or sell them for use only in manufacturing in which the prunes lose their form and identity as prunes as permitted by the Regulation Governing the Importation of Prunes (7 CFR 999.200); and that I am:

□ PROCESSOR (user of prunes for manufacturing) □ RESELLER (dealer in prunes for manufacturing)

1. DATE OF PURCHASE	2. PLACE OF PURCHASE (City and State)
3. NAME AND ADDRESS OF IMPORTER OR SELLER	4. USDA CERTIFICATION OF QUALITY AND CONDITION NUMBER

5. PRUNES ACQUIRED:

NUMBER OF CONTAINERS	TOTAL NET WEIGHT (pounds)

NAME OF FIRM:

ADDRESS:

SIGNATURE OF AUTHORIZED OFFICIAL

TITLE

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 0581-0178. 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-171 (Exp. x/xxxx) Destroy previous editions.

DISTRIBUTION: Original – Specialty Crops Program, AMS, Washington, D.C. 20250; Copy – Retained by Importer; Copy – Retained by Purchaser