Download:
pdf |
pdfPlease complete and fax to (209) 550-5494
OMB Approval NO.0581-0178
ABC Form 42
Almond Board of California
Handler Information Sheet
Handler Name:
Address:
City, State, Zip
Telephone:
Fax Number:
Company is (check one): Ifadditional space is needed, use reverse side.
J Sole proprietorship.
Name of Owner:
Residence Address:
City, State, Zip
(
) Partnership. Please give names and residence addresses of all partners. If a limited
artnershi I lease indicate. Limited artners need not be listed).
Name of Partner
)
Residence Address of Partner
Corporation. Please give names and residence addresses of officers (if applicable).
Chairman:
President:
Vice President:
Secretary:
Treasurer:
State Incorporated In:
This will acknowledge that I have received a copy of Marketing Order NO.981, a copy of the Administrative
Rules and Regulations and a list of Handler Responsibilities for the 2007/2008Crop
Year.
Date
Signed
Title
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 infonnation
unless it displays a valid OMB control number. The valid OMB control number for this infonnation 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 cx:isting data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of infonnation.
The U.S. Department of Agriculture (USDA) prohibits discrimination in aU 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, scx:ual orientation, genetic information, political beliefs, reprisal, or because all or part of
an individual's income is derived &om any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require a1tcmative
means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TOD).
To ftle 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 (TOD). USDA is an equal opportunity provider and employer.
File Type | application/pdf |
File Modified | 2007-08-01 |
File Created | 2007-08-01 |