OMB No. 0581-0189

Exp. 1/31/2027. Destroy previous editions.

TEXAS VALLEY CITRUS COMMITTEE No. __________________

901 Business Park Drive, Suite 400

Mission, Texas 78572

Telephone: (956) 581-2190

ORANGE AND GRAPEFRUIT DIVERSION REPORT

Issued under authority of Certificate of Privilege No. ______________ Date _______________________

Receiver:_____________________________________________________________________________________

Name of approved processor, charitable organization, relief, or otherwise

Address _____________________________________________________________________________________

Truck Lic.: _____ Trailer Lic.: ______ Inspection Cert. No.: ______ R.R. Car Initial & No.: ______

Quantity (Total Lbs. Net Actual or 

Estimate)

_______Grapefruit ________Oranges

Charity/Relief Grapefruit Containers Total Lbs. Net

Oranges Containers Total Lbs. Net

Otherwise Diverted Grapefruit Containers Total Lbs. Net

Oranges Containers Total Lbs. Net

The undersigned certifies that these oranges or grapefruit are diverted from fresh fruit channels in accordance with 

the regulations of the Texas Valley Citrus Committee (Committee).

______________________________________ _______________________________________

Handler Authorized Representative

TO BE FILLED IN BY RECEIVER:

Quantity received: ________________ Grapefruit _________________ Oranges

The undersigned acknowledges receipt of the above fruit and certifies that it will be diverted from fresh channels in 

accordance with the Committee regulations.

________________________________________ _____________________________________

Receiving Organization Authorized Representative

The making of any false statements or representation in any matter within the jurisdiction of any agency of the United States, 

knowing it to be false, is a violation of Title 18, section 1001 of the United States Code, which provides for a penalty of a fine or 

imprisonment, or both.

INSTRUCTIONS: Mail the white (original) copy of this form to the Committee. The canary (duplicate) and pink (triplicate) 

copies must be given to the party receiving the fruit. Upon arrival at the destination, the party transporting the fruit must give 

both copies to the party actually receiving the fruit, whereupon said party must insert the net weight of the fruit received, sign, 

and promptly mail the canary copy to the Committee. The pink copy may be retained by the manufacturer for filing purposes. 

The gold (quadruplicate) copy may be retained for filing purposes by the Handler authorizing movement of this fruit.

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 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.
OMB No. 0581-0189

Exp. 1/31/2027. Destroy previous editions.

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.