CWB Export #B Consummation of Sale & Transmittal of Supporting Documen

California Walnut Board OMB No. 0581-0178

101 Parkshore Drive, Ste. 250 CWB Export Form #B

Folsom, CA 95630 Report No. __________________

Ph (916) 932-7070 Fax (916) 932-7071 Date: ______________________

CONSUMMATION OF SALE AND TRANSMITTAL OF SUPPORTING DOCUMENTS

In executing this form, the handler respectively certifies to the California Walnut 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 supporting documents:

Unit (Number & Type)	Net Weight (pounds)	Size & Grade	Inspection Certificate No.	Price Per Pound

NAME OF CARRIER _____________________ SHIPPING CONTAINER NO. _______

EXPORTED TO _________________________ BROKER _______________________

(country)

Include the Following Information:

Copy of Invoice to Buyer No. ________________

Signed "On-Board" or

"Received for Shipment" No. ________________

Letter of Credit No. ____________________ Issued by:______________________________

(Name of Bank)

Date Paid __________________________

Cash in Advance:

Date payment received ____________________

Form of payment:

1) Check No. __________, issuing bank __________________, date _____________

2) Bank Draft No. ______________________, date ___________________________

3) Bank Transfer No. ____________________, date ____________________________

4) Other - specify _______________________________________________________

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 the penalty of a fine of $250,000 for individuals and $500,000 for organizations or imprisonment of not more 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 this form to the California Walnut 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 collection 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 of an 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.

Rev. 04/09