CMB 8 CA Walnuts - Rept. of Interhandler Transfers of Walnuts

OMB No. 0581-0178

California Walnut Board

101 Parkshore Drive, Suite 250

Folsom, CA 95630-4726

Ph (916) 932-7070; Fax (916) 932-7071

REPORT OF INTERHANDLER TRANSFERS OF WALNUTS

This report of walnuts transferred between handlers 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 (Board) and to the U.S. Department of Agriculture as to the correctness and completeness of their statement.

Instructions: 1. Report date of transfer and if DFA certified.

2. Report inshell and shelled interhandler transfers (in pounds).

3. Sender sends two copies of the form to the receiving handler.

4. Mail a signed original to the Board following each transfer or receipt of walnuts, within 10 working days.

INTER-HANDLER TRANSFERS (in pounds)
Date of Transfer	DFA Certified	Inshell/Shelled	Net Weight
	Yes / No
	Yes / No
	Yes / No
	Yes / No
	Yes / No
	Yes / No
TOTAL

To be completed by Transferring Handler To be completed by Receiving Handler

The above walnuts were received

_______________________________ ___________________________, 20_________

(Name of Handler)

By_____________________________ _________________________________________

(Name of Handler)

By________________________________________

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, of the United States Code, which provides for a penalty of a fine for individuals and for organizations or imprisonment, 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.

CWB 8 (Rev. 10/2010. Destroy previous editions.)