ABC 42 CA Almonds Handler Information Sheet

Please 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.
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where applicable, sex, marital status, familial status, parental status, religion, scx:ual orientation, genetic information, political beliefs, reprisal, or because all or part of
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