F/H Form 4 Hazelnuts Declaration of Inshell Hazelnuts

F/HFonn4
OMB CONTR. NO.
0581-0178

HAZELNUT MARKETING BOARD
21595 A Dolores Way NE
Aurora, OR 97002-9738

DECLARATION OF INSHELL HAZELNUTS
Theundersignedhandlerherebydesignatesthat as of

,

20

J

the followinglots of certified

inshell hazelnuts are to be considered as handled on the domestic market by the Hazelnut Marketing Board and subject to
such restricted obligation as may accrue from such handling:
Pounds

Dated

Location

Size

HANDLER
By
Title

Shipments from the above are to be reported at the end of the month shipped.

No handler may elect to have the certified merchantable hazelnuts which have not been handled at the end of a marketing
policy year bear the rest5ricted and assessment obligations of that year or of the marketing policy year in which handled
unless a completed declaration is made to the Board (7 U.S.C. 608(d), 7 CFR 982.50 and 7 CFR 982.450).

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 ofirrformation
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 20 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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