OMB No. 0581-0177

Cherry Industry Administrative Board
TART CHERRY ORCHARD MAP
GROWER NAME:					CIAB #:	PHONE:	
ADDRESS:						CITY:			       STATE:		ZIP:	
BLOCK NAME:					BLOCK #:	COUNTY:	
Township:	__________
Section #:	__________ 
T: _____ R: _____ S: _____(Example: T2N, R1W, S12)

GPS Info, Optional and if Available
Lat.	Long.
Row 1, Tree 1	___E  ___’  ___” / ___E  ___’  ___”
Point 2		___E  ___’  ___” / ___E  ___’  ___”
Point 3		___E  ___’  ___” / ___E  ___’  ___”
Point 4		___E  ___’  ___” / ___E  ___’  ___”
Point 5		___E  ___’  ___” / ___E  ___’  ___”
Point 6		___E  ___’  ___” / ___E  ___’  ___”
Point 7		___E  ___’  ___” / ___E  ___’  ___”
Point 8		___E  ___’  ___” / ___E  ___’  ___”

BLOCK LOCATION:												
(Provide available info.)
	
NEAREST CROSSROADS:  ____________________ and __________________________
LOCATION DIRECTIONS:
	
GENERAL INFORMATION ABOUT THIS BLOCK OF CHERRIES	
ACRES:   ____ . __      SPACING: ___ N x ___ N 
 EST. OF LIVE TREES REMAINING: ___ __ %	VARIETY:  Montmorency	  Balaton	 Meteor
 (optional)	  Other	
	
ROW NO. 1 IS ON THE    North       South       East       West   SIDE OF THE FIELD.	
PLEASE NOTE: PLEASE MAP THE BLOCK AS IT WAS ORIGINALLY PLANTED.	
ROW NO.	TREES IN ROW	YEAR PLANTED	ROW NO.	TREES IN ROW	YEAR PLANTED	ROW NO.	TREES IN ROW	YEAR PLANTED	
1			25			49			
2			26			50			
3			27			51			
4			28			52			
5			29			53			
6			30			54			
7			31			55			
8			32			56			
9			33			57			
10			34			58			
11			35			59			
12			36			60			
13			37			61			
14			38			62			
15			39			63			
16			40			64			
17			41			65			
18			42			66			
19			43			67			
20			44			68			
21			45			69			
22			46			70			
23			47			71			
24			48			72			
IF THE BLOCK IS LARGER THAN 72 ROWS, USE ANOTHER MAP FOR THE CONTINUATION AND INDICATE THAT THE SECOND MAP IS A CONTINUATION OF THE FIRST.

ATTACH OR DRAW MAP(S) THAT SHOWS BLOCK LOCATION USING SECTIONS, TOWNS, ROADS, and/or OTHER IMPORTANT LANDMARKS SO THAT THE BLOCK CAN BE EASILY FOUND.   

I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT MAPPING OF THE ORCHARD TO WHICH IT APPLIES.

Grower Signature  								  Date:  				
0177

CHERRY INDUSTRY ADMINISTRATIVE BOARD
GROWER DIVERSION APPLICATION

Crop Year 20		

To divert cherries in your orchard for Crop Year 20xx, this form must be filed at the CIAB office no later than April 15, 20	.  Along with this application, new and/or updated orchard maps for the diverted blocks must also be submitted.

Name of Grower:  						Grower #:				
Address: 												
City:  							   	State  		   Zip			
Phone number:	(	)   				

This section must be completed.  (Indicate all appropriate responses.)

A.			I have carefully reviewed the orchard maps sent to me by CIAB after January 20__ and there are NO changes to any of those blocks represented by those printouts.  I certify those printouts are a true and accurate representation of my current orchard blocks.  
B.			Attached are ___________ revised orchard maps.  The rest are the same
C.  		Attached are ___________ new orchard maps.  
		   		    (Number of maps)

I agree by participating in this diversion program that I will abide by the rules and regulations hereby established by the Board for diversion.

Authorization for Limited Sharing of Information 
	By marking this box I authorize the CIAB and the various state statistical services, including the Michigan, New York, Oregon, Pennsylvania, Utah and Wisconsin Agricultural Statistic Services, to share information regarding the layout, location and composition of my tart cherry orchards.  I recognize that this sharing of information will streamline the reporting of this information to both the CIAB and the statistical services.  This authorization shall continue for the next 5 years unless it is revoked by me in writing.				

Signature:  								Dated:				

Return by April 15, 20	  to:	
				
Cherry Industry Administrative Board
12800 Escanaba Drive, Suite A
P.O. Box 388
DeWitt, MI 48820-0388
Phone: (517) 669-1070   Toll Free: (888) 639-2422
Fax: (517) 669-1260

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 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

(REV 2013).