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 15 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.

SC-209 (Exp. 01/31/2027. Destroy previous editions.) Page 1 of 2

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

U.S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SPECIALTY CROPS PROGRAM

HANDLER

REGISTRATION

Avocado Administrative Committee

P.O. Box 900188

Homestead, FL 33090-0188

Tel: (305) 247-0848

1. In accordance with the authority granted by the Secretary of Agriculture for the marketing of avocados grown in

South Florida, under Marketing Order No. 915, I hereby apply for registration as an avocado handler, consistent

with 7 CFR § 915.120.

2. NAME 2a. EMAIL ADDRESS

2b. HOME ADDRESS (City, County, State, and Zip Code)

2c. BUSINESS ADDRESS (City, County, State, and Zip Code)

2d. HOME TEL. NUMBER (include area code) 2e. BUSINESS TEL. NUMBER (include area code)

3. ADDRESS WHERE FRUIT WILL BE PACKED

4. NAME OF PERSON RESPONSIBLE FOR PACKING FRUIT

5. FORM OF BUSINESS ORGANIZATION

□ Individual □ Partnership □ Corporation □ Cooperative

IF INCORPORATED, IN WHAT STATE?

6. NATURE OF BUSINESS

□ Handler □ Trucker □ Shipper □ Gift fruit shipper

7. NUMBER OF YEARS ENGAGED IN AVOCADO 8. ESTIMATED SEASONAL VOLUME OF

BUSINESS AVOCADOS HANDLED

9. NAME OF BUSINESS

10. IF OTHER THAN INDIVIDUAL, GIVE NAMES AND ADDRESSES OF OFFICERS, PARTNERS, ETC.

Name Title Address

11. WILL YOU HANDLE ONLY FRUIT THAT YOU, YOURSELF, OWN AND GROW?

□ YES □ NO

12. NAME AND ADDRESS OF THREE REFERENCES, ONE OF WHICH SHALL BE A BANK

Name Address
REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0189

13. THE FOLLOWING FACILITIES ARE NEEDED FOR PACKING AVOCADOS, PLEASE INDICATE

COMPLIANCE

a. Permanent location? Yes No b. Facilities under cover? Yes No

c. Proper lighting? Yes No d. Approved scales available? Yes No

Mark “X” in appropriate block YES NO

14. DO YOU HAVE A CURRENT PERISHABLE AGRICULTURAL COMMODITIES 

ACT (PACA) LICENSE? (A COPY MUST ACCOMPANY APPLICATION)

15. DO YOU HAVE A CURRENT FLORIDA DEALER’S LICENSE*? 

16. DO YOU HAVE A CURRENT FLORIDA AGRICULTURAL BOND*? 

17. DO YOU HAVE A CURRENT DADE COUNTY OCCUPATIONAL LICENSE*? 

18. HAVE YOU, OR OTHER PRINCIPALS IN YOUR BUSINESS, EVER BEEN 

CONVICTED OF A FELONY?

19. ARE YOU AWARE OF FEDERAL MARKETING ORDER NO. 915 THAT GOVERNS 

THE MARKETING OF AVOCADOS GROWN IN SOUTH FLORIDA?

20. HAVE YOU READ AND STUDIED THE REQUIREMENTS FOR U.S. GRADE 

STANDARDS OF AVOCADOS?

21. DO YOU AGREE TO NOTIFY THIS OFFICE IMMEDIATELY IF THE ANSWER TO 

ANY OF THE PRECEEDING QUESTIONS CHANGE OVER TIME?

22. DO YOU UNDERSTAND THE CONDITIONS UNDER WHICH YOUR 

CERTIFICATE OF REGISTRATION MAY BE SUSPENDED OR REVOKED, AS

OUTLINED IN 915.120 IN FEDERAL MARKETING ORDER NO. 915?

CERTIFICATION OF STATEMENT: I (we) hereby agree to comply with all of the requirements of the

Marketing Order regulating the handling of avocados grown in the Florida production area and with all the rules and

regulations issued thereunder.

SIGNATURE OF APPLICANT DATE

STATE OF FLORIDA, COUNTY OF _____________________________. Before me the undersigned authority,

personally appeared ____________________________________, who, being duly sworn, stated that he (she) is

_________________________________ of ______________________________________, and that the statements

contained herin are correct to the best of his (her) knowledge and belief.

_________________________________________________

NOTARY PUBLIC

NOTE: The making of any false statements or representations 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, United States Code, which

provides for a penalty of a fine or imprisonment, or both.

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-209 (Exp. 01/31/2027. Destroy previous editions.) Page 2 of 2