CIAB Form #2 Cherries Acquired from Producers

C

CIAB

FORM #2

OMB # 0581-0177

Crop Year

HERRIES ACQUIRED from PRODUCERS

C herry Industry Administrative Board

P.O. Box 388, DeWitt, MI 48820-0388

Tel: 517/669-1070 Fax: 517/669-1260

The report covers the current crop year from July 1 to October 30. List all fruit received using the raw product volume of fruit delivered. The report is due at the CIAB offices by close of business, Eastern time, on September 15.

Handler: Handler ID#

Address:

City, ST Zip:

Telephone No.:

All Weights are to be listed at Raw Product Equivalents (RPE)

Grower Name CIAB ID#			District # or Name	Cherries Delivered (actual pounds)
1		G
2		G
3		G
4		G
5		G
6		G
7		G
8		G
9		G
10		G
11		G
12		G
13		G
14		G
15		G
16		G
17		G
18		G
19		G
20		G
21		G
22		G
23		G
24		G
25		G

The undersigned hereby certifies to the CIAB and the Secretary of Agriculture that this is a true, correct and complete

report of the raw product received by the Handler for the current year.

By:

Title:

Date:

Page of

(Please see other side for additional information)

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 0581-0177. 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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.