OMB No. 0581-0178

PMC 4.72B (Exp. 3/31/2024) Destroy previous editions.

PRUNE MARKETING COMMITTEE PMC Approval No.:_______________

3840 Rosin Court, Suite 170

Sacramento, CA 95834

FOREIGN EXPORT NOTICE OF USAGE OF SUBSTANDARD PRUNES 

FOR MANUFACTURING PURPOSES

NOTE: Do not complete or forward until this entire shipment of prunes has been used. 

CERTIFICATION: The under signed hereby certifies to the United States Department of Agriculture and 

to the Prune Marketing Committee (Committee) that the following described shipment of dried 

substandard prunes has been used for the following manufacturing purpose:

___________________________________________

Date prunes were received: ______________________________________________________________

Net weight used: _______________________________________________________________________

Date usage was completed: ______________________________________________________________

Name and address of processing firm: ______________________________________________________

Name and address of purchasing firm: _____________________________________________________

Signed: ______________________________ Title: ___________________ Date: ______________

INSTRUCTIONS: Complete in triplicate immediately upon usage of the described dried substandard

prunes. Return the original to the Committee. Return a copy to your supplier, and

retain a copy for your records. 

IMPORTANT NOTICE: This report is required by law (7 U.S.C. 608(d), 7CFR 993.50(e), 993.73 and 

993.150(e)). 

FAILURE TO REPORT can result in a fine for each such violation and each day during which such 

violation continues shall be deemed a separate violation. The issuance of a false certificate, knowing it to

be false, is a violation of title 18, section 1001 of the United States Code, which provides a penalty of a 

fine or imprisonment, or both. 

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.