ACP-8 Producer Delivery Report

OMB No. 0581-0215
Administrative Committee for Pistachios
4938 East Yale Avenue, Suite 102
Fresno, CA 93727
Tel (559) 255-6480; Fax (559) 255-6485
Email: [email protected]

ADMINISTRATIVE COMMITTEE FOR PISTACHIOS
PRODUCER DELIVERY REPORT INSTRUCTIONS
20_ _- 20_ _
Processor Name: Please provide the processor name.
Entity Name: Provide the name of the grower from which the pistachios originated.
Tax Identification Number: Federal Tax Identification Number (FEIN) or Social Security Number
(SSN) of the entity from which the pistachios originated. Please do not leave this blank, as it is
required to verify the entity listed.
Entity Type: Provide the entity type (i.e., individual/sole proprietorship, partnership, corporation, LLC
or trust). If the producer is a partnership, corporation, LLC or trust, provide a FEIN. If the producer is an
individual (sole proprietorship), provide his/her SSN. (In some instances, an individual may use a FEIN
instead of a SSN).
Authorized Voter: Provide the name of the authorized voter of the producer (the individual owner of a
sole proprietorship, the general partner of a partnership, the managing officer of a corporation, the
managing member of an LLC, or the trustee of a trust), and their contact information. This individual is
the person who will be authorized to vote on behalf of the producer in Committee elections and
referenda, and ballots will be mailed to the address provided.
Note: If the deliveries are part of a group of producers combined for purposes of reporting and
payment (such as a cooperative or various producers represented by a farm manager acting as
agent), the name, mailing address, SSN or FEIN and other information required by these
instructions must be provided for each of the individual producers. The names, addresses and
FEIN or SSN provided by each processor will be the basis for verifying eligibility to vote in
Committee elections and referenda. If you have questions, please call the ACP at 559-255-6480
for clarification.
Bearing Acres: Provide the total bearing acres for each producer.
County: Report the county in which the pistachios were produced. Do not report the county in which the
producer lives. If property is located in two counties, report both counties and an estimate of the pounds
produced in each county.
Producer Deliveries: Report the total open inshell, closed shell and shelling stock (in pounds) processed
for each producer. Report all weights on an inshell basis. Use actual inshell weight of closed shell and
shelling stock. For loose kernels, multiply the actual weight by two to obtain an inshell weight.
Total Pounds Processed: Provide the combined total pounds processed for each producer.
Verification: Please date, sign (authorized representative) and provide your title on the form. Please
return the original, signed copy to the ACP with your Assessment Report and payment on or before
the December 15, 20___ postmark deadline.

ACP-8 (Rev. 05/2014. Destroy previous editions.)

OMB No. 0581-0215
Please read instructions thoroughly before completing this report.

PRODUCER DELIVERY REPORT
Crop Year:
PROCESSOR NAME:

PRODUCER DELIVERIES (IN POUNDS)
*AUTHORIZED VOTER

ENTITY NAME
Name:
Tax Identification Number:

(Individual, General Partner, Corporate Officer or Trustee)

Name:
Mailing Address:

___
___

Sole Proprietorship
Corporation

Telephone No.:

___

Partnership

Fax No.:

___
___

LLC

Email Address:

Trust

Name:
Tax Identification Number:

TOTAL BEARING ACRES:
Name:
Mailing Address:

___

Sole Proprietorship

___

Corporation

Telephone No.:

___

Partnership

Fax No.:

___
___

LLC

Email Address:

Trust

TOTAL BEARING ACRES:

Name:
Tax Identification Number:
Sole Proprietorship
___

Name:
Mailing Address:

___

Corporation

Telephone No.:

___

Partnership

Fax No.:

___
___

LLC
Trust

Email Address:

Name:
Tax Identification Number:

TOTAL BEARING ACRES:
Name:
Mailing Address:

___

Sole Proprietorship

___

Corporation

Telephone No.:

___

Partnership

Fax No.:

LLC

Email Address:

___
___

Trust

County of
Production

TOTAL BEARING ACRES:

TOTALS - THIS PAGE ONLY

ACP-8 (Rev. 05/2014. Destroy previous editions.)

Open
Inshell

Closed
Shell

Shelling
Stock

Total Lbs.
Processed

OMB No. 0581-0215

* The individual listed in the “Authorized Voter” column will act as authorized voter on behalf of the Producer in all Administrative Committee for Pistachios elections and
referenda. The undersigned, on behalf of the reporting processor, certifies to the Administrative Committee for Pistachios and the Secretary of the United States
Department of Agriculture that this report represents a complete and accurate record of producer deliveries.

___________________________
Date

__________________________________________________________
Authorized Representative

_______________________________________________
Title

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting
the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the
requested information is necessary for the administration of the marketing order program. Submission of the Tax Identification Number (TIN) is mandatory, and will be used to
validate ballots and determine affiliation or entity identity. Please note that ballots will not become invalid if a TIN is not disclosed. 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 fine 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 0581-0215. The time required to complete this information collection is estimated
to average 12 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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue SW, Washington, DC 20250-9410, or call (800) 795-3272 (voice)
or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

ACP-8 (Rev. 05/2014. Destroy previous editions.)