WMB Export Form B CA Walnuts Consummation of Sale & Transmittal of Support

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

OMB NO. 0581-0178
WMB Export Fonn fIB

Report~
Dabr. ;.

-

CONSUMMATION OF SALE AND TRANSMITTAL OF
SUPPORTING DOCUMENTS
In executing ~Is fonn. the handler respectively certifies to the Walnut Marketing Board and to the U.S. Department of Agriculture
as to the correctness and completeness of their statement.

We have consummated sale of the reserve walnuts described below at the price recorded and
hereby submitted with the required s4Pporting documents:
.

Unit
(Number &Type)

Net Weight

(pounds)

.

Inspection
Certificate No.

Size & Grade

Price Per
Pound

,.

NAME OF CARRIER

SHIPPING CONT AtHER NO.

EXPORTED TO

BROKER
(country)

Include the Following Information:
Copyof Invoiceto Buyer

No.

Signed "On-Board" or
"Received for Shipment"

No.

LetterofCreditNo.

Issued by:
(Name of Bank)

Date Paid
Cash in Advance:
Date payment received
Form of payment:
1) Check No.
2) Bank Draft No.
3) Bank Transfer No.
4) Other - specify

.issuing bank

, date
, date
, date

The making of any false statements orntpl'888ntat1onsln any mattarwlthln the JurtiJdlctlonQ(Oy'agency of the Unltad
States. knowing IUD be false. Is a violation ofTJtle 18, SectIon 1001. Unlt8cf"StatesCode. whiCh provides for1he penalty
of a fine of $250,000 for Individuals and $500.000 for organJzatlons or Imprisonment of not mont than five years, or both. '.

Date Shipped
Handler

By
Title

Note: No credit for reserve disposition for export by the handler In accordanCe with the export
agent agreement can be obtained without first submitting thi~ fonn to the Walnut
Marketing Board (7CFR 984.56(b), 7CFR 984.456(a».
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 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 colIection 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 ofan 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.