G-1 Spearmint-Allotment Base Transfer (Class 1 & 3)

OMB No. 0581-0178

FAR WEST SPEARMINT OIL ADMINISTRATIVE COMMITTEE

100 N. Fruitland, Suite B

Kennewick, WA 99336

Phone: (509) 585-5460

ALLOTMENT BASE TRANSFER FORM

Pursuant to section 985.59 of Marketing Order No. 985

1. Producer TRANSFERRING BASE

Growers No.: _____________________

TRANSFEROR desires to remain on Committee Mailing List: □ Yes □ No

2. Producer ACQUIRING BASE

Growers No.: _____________________

3. Quality & Class being transferred: ___________ Pounds of Native or Scotch Class __________
   (Circle One) (Indicate 1, 2, 3 or 4)

4. Effective date of transfer: _____________________

5. Crop year when transfer to become effective: ___________________

6. Signature of Producer TRANSFERRING Base:

I certify that the above amounts, class, and dates are correct. ___/___/___ _______________________

___/___/___ _______________________

7. Signature of Producer ACQUIRING Base:

I certify that the above amounts, class, and dates are correct and that I have the land and the equipment necessary to produce the oil to meet the bona fide effort requirement associated with this base.

___/___/___ _______________________

___/___/___ _______________________

8. Signature of Committee agent executing transfer: ___/___/___ _______________________

9. Signature of Manager: ___/___/___ _______________________

Transferring Acquiring

Allotment Base Prior to Transfer

Quantity Transferred -__________ +_________

Allotment Base after Transfer

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 5 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.

G-1 (Rev. 01/2014. Destroy previous editions.)