OMB No. 0581-0178

PMC 4.12 (Exp. 3/31/2024) Destroy previous editions.

RESERVE PRUNES HELD BY HANDLER

FOR ANIMAL FEED DISPOSITION

To: Prune Marketing Committee 

3840 Rosin Court, Suite 170

Sacramento, CA 95834

HANDLER: __________________________________________________________________________

ADDRESS: __________________________________________________________________________

We report below the locations and tonnages of reserve pool prunes available for shipment to animal feed 

disposal during the month of ________________________, 20___. The Prune Marketing Committee

may issue their Warehouse Releases to instruct shipment of all or any part of these prunes during the 

month noted above. 

Plant 

Designation Street & Number City Phone Name of Contact Tons

Handler: _______________________________

Signature: ______________________________

Title: __________________________________

IMPORTANT NOTICE: 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 10 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.