COC-17 Olives-Final Assessment Payment

OMB No. 0581-0178

FINAL ASSESSMENT PAYMENT

20___ CROP YEAR

Date: _________________________, 20___

TO: California Olive Committee 770 E. Shaw Avenue, Suite 310 Fresno, CA 93710

(2) FROM:

(3) Report of olives first handled and used in the production of canned ripe olives.

VARIETY	CANNING	LIMITED	EXEMPT	ESTIMATED EXEMPT	TOTAL EXEMPT	TOTAL ASSESSED TONS
Sevillano
Ascolano
Manzanillo
Mission
Barouni
Obliza
TOTAL

(4) TOTAL ASSESSMENTS (ASSESSABLE TONNAGE x ____ PER TON) $_____________

(5) LESS TOTAL PAYMENTS TO DATE $_____________

(6) BALANCE OF ASSESSMENT NOW DUE AND PAYABLE $_____________

(7) OLIVES FOR THIS CROP YEAR HAVE ALL BEEN PACKED? YES □ NO □

(8) CERTIFICATION AND SIGNATURE: The undersigned, on behalf of the reporting handler, certifies to the California Olive Committee and the Secretary of Agriculture of the United States that this report represents a complete and accurate record of all olives handled (as defined in section 932.16 of Marketing Order No. 932.)

______________________________ _________________ ___________ _____________________

Authorized Signature Title Date EIN

Attach schedule (form COC-14) for computing exempt tonnage to date. If exempt estimate is used for storage olives, report on reverse side “STORAGE HOLDINGS.” OLIVES HELD IN STORAGE AS OF ______________________.

VARIETY	CANNING TONNAGE	LIMITED TONNAGE
TOTAL

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the administration of the marketing order program.

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.

COC-17 (Rev. 10/2010. Destroy previous editions.)