WMB 6 Report of Merchantable Wallnuts Shipped

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OMB NO. 0581-0178
WMB Form #8
Due Date:
Month:

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1540 River Park Drive, Suite 203
Sacramento CA 95815-4609
Ph (916) 922-5888 Fax (916) 923-2548

REPORT OF MERCHANTABLE WALNUTS SHIPPED
This report of merchanu.ble walnuts shipped is submitted Incompliance withthe requirements of the Federal MarketingOrder No.
984. as amended. In executing this form. the handler respectively certifies to the Walnut Marketing Board and to the U.S.
Department of Agricultureas to the correctness and completeness of their statement.

Instructions:

1. Report Inshell and shelled by domestic and export shipments (In pounds).
2. Report all export shipments by country of destination on the attached page.
3. Ifyou did not make any shipments. write "NONE"on the form.
4. Malla signed originalto the Walnut MarketingBoard (WMB)officeon or before

WALNUT SHIPMENTS (In pounds)
Inshell
Domestic

.

Shelled

.

Export
TOTAL
Handler:
By:
Title:

Date:

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 of $250,000for Individuals and $500,000for organizations or Imprisonment of not more than flye ~al'8, or both.
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 0581-0178. The time required to complete this information collection is estimated to average 10
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 ofrace, 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 ITomany
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.