Form APC Form 1 APC Form 1 Summary Rept. US Pecans Received

REPRODUCE LOCALLY. Include form number and date on all reproductions.

OMB No. 0581-NEW

SUMMARY REPORT
U.S. PECANS RECEIVED FOR YOUR OWN ACCOUNT
APC Form 1 - Instructions
Section 7 CFR 986.177 of the Pecan Marketing Order requires each Handler to tabulate their Inshell receipts (by weight) by Variety
and to record this information on APC Form 1. The completed form is to be delivered to the American Pecan Council (APC) no later
than the tenth day of the month. The Council staff will compile the data and will subsequently provide industry-wide reports to each
Handler and the public.

Please note:
You need only insert data in the blank WHITE cells. The APC staff will complete any information in the 'SHADED' cells. If
completing the form electronically, once the information is entered, the column totals, and the amount of the assessment owed, will be
calculated automatically. If completing the form by hand, the amounts you provide, and the assessment owed, will be calculated by the
APC staff.
If there are no changes since the previous month submmission, place an 'X' in the appropriate space at the bottom of 'Reporting
Period' column, then follow the instructions below for "UPON COMPLETION".
The following are instructions for completing APC Form 1 - Summary Report:

Date Completed:
Insert the date the report is being completed in the blank provided at the upper left of the form
Reporting Period:
Place a check mark next to the appropriate month for the current report.
Current Period Total (Inshell Basis):
Insert the the total weight of US Inshell received during the current reporting period in the blank white cell next to the
appropriate variety. If you have received a variety that does not appear in the list, you can either record them under 'other' or
add the variety(ies) in one of the blank white cells on the list of varieties. For clarification purposes, 'Deisrable Type' includes
any variety similar to Desirables (i.e. Cunard, Forkert, Kiowa, Mandan, Moreland, Morill, Oconee, etc.).
UPON COMPLETION: Read the Certification statement at the bottom of the form and write in/type the Handler/Company name, the
name of individual completing the form and the Handler Number. Then sign in the space provided and fax the form to ___________,
(___) _____-_______ or e-mail to ____________@_____.

§986.81   Confidential information.
All reports and records submitted by handlers to the Council, which include data or information constituting a trade secret or disclosing the trade position, or
financial condition or business operations of the handler, shall be kept in the custody of one or more employees of the Council and shall be disclosed to no
person except the Secretary of Agriculture.

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-NEW. The time required to complete this
information collection is estimated to average 20 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.

APC Form 1 (11/2017)

REPRODUCE LOCALLY. Include form number and date on all reproductions.
American Pecan Council

OMB No. 0581-NEW

Date completed:

SUMMARY REPORT
U.S. PECANS RECEIVED FOR YOUR OWN ACCOUNT
This report is submitted pursuant to 7 CFR 986.177 and is subject to audit
verification by the American Pecan Council (7 CFR 986.79)

PECAN
Varieties

Assessed
Rate

Blends/Mixed Budded

$0.03

$0.00

0

=

0

Bradley

$0.03

$0.00

0

=

0

Caddo

$0.03

$0.00

0

=

0

Cape Fear

$0.03

$0.00

0

=

0

09/01 to 09/30

Cheyenne

$0.03

$0.00

0

=

0

Creek
Desirable

$0.03

$0.00

$0.03

$0.00

0
0

=
=

0
0

Desirable Type

$0.03

$0.00

0

=

0

Eastern Schley

$0.03

$0.00

0

=

0

Elliott

$0.03

$0.00

0

=

0

Excel

$0.03

$0.00

0

=

0

Moneymaker

$0.03

$0.00

0

=

0

Pawnee

$0.03

$0.00

0

=

0

Stuart

$0.03

$0.00

0

=

0

Sumner

$0.03

$0.00

0

=

0

Western Schley

$0.03

$0.00

0

=

0

Wichita

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.03

$0.00

0

=

0

$0.02

$0.00

$0.02

$0.00

0
0

=
=

0
0

0

=

0

Reporting Period

[]

September

[]

October

10/01 to 10/31

[]

November

11/01 to 11/30

[]
[]
[]
[]
[]
[]
[]
[]
[]

December

January

February

March

April

May

June

July

August

12/01 to 12/31

01/01 to 01/31

02/01 to 02/28(9)

03/01 to 03/31

04/01 to 04/30

05/01 to 05/31

06/01 to 06/30

07/01 to 07/31

08/01 to 08/31

Other
[]

Check here if there are NO Changes
from Previous Period figures, then
complete bottom portion of form and
submit to the American Pecan
Council.

Natives/Seedlings
Substandard

Totals
I, hereby, certify to the AMERICAN
PECAN COUNCIL and to the U.S.
Secretary of Agriculture that the
information contained in this report is
complete and correct.

Current Period
Total Pounds
(Inshell Basis)

Amount Due

0

$0.00

Previous Period
Year-to -Date Total
(Inshell Basis)

Year to Date
Total Pounds
(Inshell Basis)

HANDLER/COMPANY:
By:

Signature:
Handler Number:
Handler Address:

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 imprsonment, or both.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions
participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual
orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any
program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the
responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information
may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at
any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit
your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 202509410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

Upon completion, fax or email form to ________: Fax - (___) ___-____; Email -__________@_______
APC Form 1 (11/2017)