CIAB Form #2 Cherries Acquired from Producers

C

CIAB

FORM #2

OMB # 0581-0177

Crop Year

HERRIES ACQUIRED from PRODUCERS

C herry Industry Administrative Board

P.O. Box 388, DeWitt, MI 48820-0388

Tel: 517/669-1070 Fax: 517/669-1260

The report covers the current crop year from July 1 to June 30. List all fruit received using the raw product volume of fruit delivered. The report is due at the CIAB offices by close of business Eastern time on September 1 of the year.

Handler: Handler ID#

Address:

City, ST Zip:

Telephone No.: ( ) –

All Weights are to be listed at Raw Product Equivalents (RPE)

Grower Name CIAB ID#			District # or Name	Cherries Delivered (actual pounds)
1		G
2		G
3		G
4		G
5		G
6		G
7		G
8		G
9		G
10		G
11		G
12		G
13		G
14		G
15		G
16		G
17		G
18		G
19		G
20		G
21		G
22		G
23		G
24		G
25		G

The undersigned hereby certifies to the CIAB and the Secretary of Agriculture that this is a true, correct and complete

report of the raw product received by the Handler for the current year.

By:

Title:

Date:

Page of

(Please see other side for additional information)

(REV 2013)

According the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number to this information collection is 0581-0177. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in its programs on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, and marital or familial status. (Not all prohibited bases apply to all programs). Persons with disabilities who require alternative means for communication of program information (Braille, large print, audio tape, etc.) should contact the USDA Office of Communications at (202) 720-6992 (voice) or (202) 720-7808 (TDD).

To file a complaint, write the Secretary of Agriculture, U.S. Department of Agriculture, Washington, D.C. 20250, or call 1-800-245-6340 (voice) or (202) 720-1127 (TDD). USDA is an equal employment opportunity employer.