F/H Form C(1) Hazelnuts Bond

OMB No. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823

Fax: (503) 678-6825

BOND

KNOW ALL MEN BY THESE PRESENT, the (I or we)

as Principal, and

names of Sureties

as Surety(ies) are held and firmly bound unto the Hazelnut Marketing Board, its successor or successors in the sum of __________________________________ Dollars ($________________), lawful money of the United States of America, for the payment of which sum well and truly to be made to said Hazelnut Marketing Board, we bind ourselves and each of us, our and each of our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these present.

THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the said above-bounden ____________________________________________________________________ or successors, shall well name of Principal

and truly perform all and singular the promises contained in a certain Undertaking executed by him on the ____________ day of _________________20_____, to the Hazelnut Marketing Board, whereby the Principal herein was permitted to postpone his surplus obligation as provided by section 982.54 of the Hazelnut Marketing Agreement and the Marketing Order as amended, then this obligation shall be void; otherwise to remain in full force and effect.

PROVIDED FURTHER, that this obligation may be cancelled by the Sureties, giving thirty (30) days notice in writing to the Secretary of the Hazelnut Marketing Board, Aurora, Oregon, but such cancellation shall not affect any liability which has accrued under this obligation prior to the effective date of cancellation.

SIGNED, SEALED AND DATED THIS ___________ day of ________________________, 20____.

_________________________________ (SEAL) _________________________________ (SEAL)

Principal Surety

_________________________________ (SEAL) _________________________________ (SEAL)

Principal Surety

No deferment of restricted obligation will be granted by the Board unless a completed bond form has been received (7 U.S.C. 608(d), 7 CFR 982.54 and 7 CFR 982.454).

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 30 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.

F/H Form C(1) (Rev. 01/2014) Destroy previous editions.