F/H Form 1(b) Hazelnuts Export Inshell Shipments

F/HForm Ib

EXPORT INSHELL SHIPMENTS

OMB CONT. NO.
0581-0178

Handler
Period
Date
Shipment

Invoice
Or
Ship. No.

Insp.
No.

Giant &
JIG

Jumbo

Med.

Large

Total

Net Unit
Price *
Received

Country

CURRENT YEAR CROP

Total Current Period
Last Period Year-To-Date
TOTAL Year-To-Date
PRIOR YEAR CROP

Total Prior Year
Last Period Year-To-Date
TOTAL Year-To-Date
* Please show different sizes in a shipment as separate line items so that meaningful cost data can be reported.
This report is required by law (7U.S.C. 6708(d), and 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result ina fine of not less than $50 or
more than $5,000 for each such violation and each day during which such violation continues shall be deemed a separate violation. The issuing of a
false document, knowing it to be false, is a violation of Title 18, Section 1001, of the U.S. Code, which provides for a penalty or a fme of not more
than $10,000 or imprisonment for not more than five years, or both.
Under penalties of perjury, I declare that I have examined this report and to the best of my knowledge and belief it is true, correct and complete and
that all export sales reported have been completed in accordance with the requirements established by the Hazelnut Marketing Board.
Name
Firm
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 i'!formation collection is 0581-0178. 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
i'!formation. 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 stotus, familial status, parental status. religion, sexual orientation, genetic information, political belieft. reprisa~ or because all or part of an individual's income is
derivedfrom any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program
informalion (Braille. large print audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discriminalion, 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
emplayer.