ABC 42 CA Almonds Handler Information Sheet

OMB No. 0581-0178

ALMOND BOARD OF CALIFORNIA Complete form and fax to

1150 9th Street, Suite 1500 the Almond Board of California

Modesto, CA 95354

Tel: (209) 549-8262 Fax: (209) 550-5494

HANDLER INFORMATION SHEET

Handler Name:
Address:
City, State, Zip Code:
Telephone:
Fax Number:

Company is (check one). If additional space is needed, use reverse side.

□ Sole proprietorship

Owner Name:
Residential Address:
City, State, Zip Code:

□ Partnership

Please give names and residential addresses of all partners. If a limited partnership, please indicate such. (Limited partners need not be listed).

Partner Name:	Residential Address of Partner(s):

□ Corporation

Please give names and residential addresses of officers (if applicable).

Chairman:
President:
Vice President:
Secretary:
Treasurer:
State of Incorporation:

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 20___ - 20___ Crop Year.

________________________________ ________________________________ _____________________

Signature Title Date

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.

ABC-42 (Rev. 10/2010) Destroy previous editions.