COC-17 Olives-Final Assessment Payment

Form .CQC-17
04- 0 1
OMB 0581-0178

FINAL ASSESSMENT PAYMENT
CROP YEAR

Invoice No:
Date:

(1) TO: California Olive Committee
1903 North Fine #1 02
Fresno CA 93727
(3)
REPORT OF OLIVES FIRST HANDLED AND USED IN THE PRODUCTION OF CANNED
RIPE OLIVES.
VARlEn

LIMITED

CANNING

Sevilla no

EXEMPT

EST. EXEMPT TLT EXEMPT ASSESS
TONS

.

Ascolano
Manzanill
Mission
Barouni
Obliza

TOTAL
(4) TOTALASSESSMENTS
(ASSESSABLE
TONNAGEx

$

PERTON)

(5) LESSTOTAL PAYMENTS
TO DATE

$.

(6) BALANCEOFASSESSMENT
NOW DUEANDPAYABLE

$

(7) OUVESFORTHISCROPYEARHAVEALL BEENpACKED YES

D

t\OD

(8) CERTIFICATION
AND SIGNATURE:

The undersignedon behalfof the reportinghandlercertifiesto the CALIFORNIA
OLIVECOMMITTEE
and the
Secretary of Agricultureof the United States that this report represents a complete and accurate record of all
olives handled (as defined in Section 932.16 of MarketingOrder No. 932.)

Authorized Signature

-

Title

Date

EIN#

Attach schedule (FormCOC-14)for computing exempt tonnage to date.
If exempt estimate is used for storaqe olives,report on reverse side "STORAGE
HOLDINGS"_

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