Grower diversion Application & Tart Cherry Orchard Map

CHERRY INDUSTRY ADMINISTRATIVE BOARD
TART CHERRY ORCHARD MAP
GROWER NAME:
ADDRESS:
BLOCK NAME:

CIAB #:
CITY:
BLOCK #:

PHONE:
STATE:
COUNTY:

BLOCK LOCATION:
T: _____ R: _____ S: _____

(Provide available info.)

OMB No. 0581-0177

Township: __________
(Example: T2N, R1W, S12)
Section #: __________
NEAREST CROSSROADS: ____________________ and ________________________
LOCATION DIRECTIONS:

ZIP:

GPS Info, Optional and if Available
Lat.
Long.
Row 1, Tree 1 ___° ___’ ___” / ___° ___’ ___”
Point 2 . . . . . . ___° ___’ ___” / ___° ___’ ___”
Point 3 . . . . . . ___° ___’ ___” / ___° ___’ ___”
Point 4 . . . . . . ___° ___’ ___” / ___° ___’ ___”
Point 5 . . . . . . ___° ___’ ___” / ___° ___’ ___”
Point 6 . . . . . . ___° ___’ ___” / ___° ___’ ___”

GENERAL INFORMATION ABOUT THIS BLOCK OF CHERRIES
ACRES: ____ . __

SPACING: ___ N x ___ N

VARIETY:

EST. OF LIVE TREES REMAINING: ___ __ %
ROW NO. 1 IS ON THE

9

North

9

South

(optional)

9 East

9
9

9 West

Montmorency
Other

9

Balaton

9 Meteor

SIDE OF THE FIELD.

PLEASE NOTE: PLEASE MAP THE BLOCK AS IT WAS ORIGINALLY PLANTED.
ROW NO.

TREES IN
ROW

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

YEAR
PLANTED

ROW
NO.
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48

TREES IN
ROW

YEAR
PLANTED

ROW
NO.

TREES IN
ROW

YEAR
PLANTED

49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72

IF THE BLOCK IS LARGER THAN 72 ROWS, USE ANOTHER MAP FOR THE CONTINUATION AND INDICATE THAT
THE SECOND MAP IS A CONTINUATION OF THE FIRST.
ATTACH OR DRAW MAP(S) THAT SHOWS BLOCK LOCATION USING SECTIONS, TOWNS, ROADS, and/or OTHER
IMPORTANT LANDMARKS SO THAT THE BLOCK CAN BE EASILY FOUND.
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT MAPPING OF THE ORCHARD TO WHICH IT APPLIES.
Grower Signature

Date:

OMB No. 0581-0177

CHERRY INDUSTRY ADMINISTRATIVE BOARD
GROWER DIVERSION APPLICATION

Crop Year 20xx
To divert cherries in your orchard for Crop Year 20xx, this form must be filed at the CIAB office no later
than April 15, 20xx. Along with this application, new and/or updated orchard maps for the diverted
blocks must also be submitted.
Name of Grower:
Address:
City:
Phone number:

Grower #:
State
(

Zip

)

This section must be completed. (Indicate all appropriate responses.)
A.
B.
C.

I have carefully reviewed the orchard maps sent to me by CIAB after January 20__ and
there are NO changes to any of those blocks represented by those printouts. I certify
those printouts are a true and accurate representation of my current orchard blocks.
Attached are ___________ revised orchard maps. The rest are the same
Attached are ___________ new orchard maps.
(Number of maps)

I agree by participating in this diversion program that I will abide by the rules and regulations hereby
established by the Board for diversion.
AUTHORIZATION FOR LIMITED SHARING OF INFORMATION
9 By marking this box I authorize the CIAB and the various state statistical services, including the Michigan,
New York, Oregon, Pennsylvania, Utah and Wisconsin Agricultural Statistic Services, to share information
regarding the layout, location and composition of my tart cherry orchards. I recognize that this sharing of
information will streamline the reporting of this information to both the CIAB and the statistical services. This
authorization shall continue for the next 5 years unless it is revoked by me in writing.
Signature:

Dated:

Return by April 15, 20xx to:
Cherry Industry Administrative Board
12800 Escanaba Drive, Suite A
P.O. Box 388
DeWitt, MI 48820-0388

Phone: (517) 669-1070 Toll Free: (888) 639-2422
Fax: (517) 669-1260
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 collection is 0581-0177. 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.
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