CWB 6 CA. Walnuts - Report of Merchantable Wallnuts Shipped

OMB No. 0581-0178

California Walnut Board Due Date: __________, 20___

101 Parkshore Drive, Suite 250 Month: __________________

Folsom, CA 95630

Ph (916) 932-7070; Fax (916) 932-7071

REPORT OF MERCHANTABLE WALNUTS SHIPPED

This report of merchantable walnuts shipped is submitted in compliance with the requirements of the Federal Marketing Order No. 984, as amended. In executing this form, the handler respectively certifies to the California Walnut Board (Board) and to the U.S. Department of Agriculture as to the correctness and completeness of their statement.

Instructions: 1. Report walnut receipts for the month in Inshell Pounds.

2. Report inshell and shelled by domestic and export shipments (in pounds).

3. Report all export shipments by country of destination on the attached page.

4. If you did not make any shipments, write “NONE” on the form.

5. Mail signed original to the Board on or before _____________, 20__.

WALNUT RECEIPTS
	Inshell Pounds
Received for the month of _________________:

WALNUT SHIPMENTS (in pounds)
	Inshell	Shelled
Domestic
Export
TOTAL

Handler: _____________________________________________________________________________

By: _________________________________________________________________________________

Title: ___________________________________________ Date: ___________________________

The making of any false statements or representations in any matter within the jurisdiction of any agency of the United States, knowing it to be false, is a violation of title 18, section 1001, of the United States Code, which provides for a penalty of a fine for individuals and for organizations or imprisonment, or both.

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 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.

SHIPMENTS BY COUNTRY OF DESTINATION

	INSHELL (Pounds)	SHELLED (Pounds)		INSHELL (Pounds)	SHELLED (Pounds)
N. AMERICA			ASIA/PACIFIC RIM
Canada			Australia
Mexico			China
EUROPE			Hong Kong
Austria			India
France			Japan
Germany			Korea
Greece			Malaysia
Italy			New Zealand
Latvia			Philippines
Netherlands			Singapore
Norway			Taiwan
Spain			Thailand
Sweden
Switzerland			CENTRAL AND SOUTH AMERICA
U.K.			Brazil
MIDDLE EAST/AFRICA			Chile
Algeria			Ecuador
Egypt			Venezuela
Israel
Jordon			OTHER (please list):
Morocco
Saudi Arabia
Turkey
U.A.E.			TOTALS

CWB 6 (Rev 01/2014. Destroy previous editions.)