CWB 6 Report of Merchantable Walnuts Shipped

California Walnut Board OMB No. 0581-0178

101 Parkshore Drive, Suite 250 CWB Form #6

Folsom, CA 95630 Due Date: __________

Ph (916) 932-7070 Fax (916) 932-7071 Month: _____________

REPORT OF MERCHANTABLE WALNUTS SHIPPED

This report of merchantable walnuts shipped is submitted in compliance with the requirements of the Federal Marketing Order No. 984, as amended. 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.

Instructions: 1. Report inshell and shelled by domestic and export shipments (in pounds).

2. Report all export shipments by country of destination on the attached page.

3. If you did not make any shipments, write “NONE” on the form.

4. Mail a signed original to the California Walnut Board (CWB) office on or before ___________.

WALNUT SHIPMENTS (in pounds)
	Inshell	Shelled
Domestic
Export
TOTAL

Handler: _______________________________________________________________________________

By: ___________________________________________________________________________________

Title: ____________________________________________ Date: _______________________________

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 a penalty of a fine of $250,000 for individuals and $500,000 for organizations or imprisonment of not more than five years, or both.

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 10 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.

OMB No. 0581-0178

CWB Form #6

Due Date: __________

Month: ____________

SHIPMENTS BY COUNTRY OF DESTINATION

	INSHELL (Pounds)	SHELLED (Pounds)		INSHELL (Pounds)	SHELLED (Pounds)
NORTH AMERICA			OTHER EUROPE
Canada			Austria
Mexico			Canary Islands
			Malta
EUROPE			Norway
Belgium			Sweden
Denmark			Switzerland
France
Germany			CENTRAL & SOUTH AMERICA
Greece			Brazil
Italy			Chile
Netherlands			Ecuador
Portugal			Panama
Spain			Venezuela
U.K.
			MIDDLE EAST/AFRICA
PACIFIC RIM			Egypt
Australia			Israel
China			Saudi Arabia
Hong Kong			Turkey
Japan			U.A.E.
Korea
Philippines			OTHER (please list):
Singapore
Taiwan			TOTALS

Rev. 04/09