F/H Form C(3) (982) Hazelnuts Acknowledgement of Bonding Requirement

OMB NO. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823

Fax: (503) 678-6825

ACKNOWLEDGE OF BONDING REQUIREMENT

Number __________________

Issued to:

This will acknowledge receipt of the “Hazelnut Marketing Board Bonding Undertaking,” F/H Form C, together with the “Hazelnut Marketing Board Bond,” F/H Form C(1) and/or F/H Form C(2), and finding no evidence to the contrary, handler stated above, to become effective:

_____________________________________

and to terminate on

____________________________________

Your limit of outstanding liability at any one time will be __________________ pounds.

HAZELNUT MARKETING BOARD

By ____________________________________

authorized agent

Date of issue ______________ 20_____.

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 OMB 0581-0178. The time required to complete this information collection is estimated to average XXX 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.

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F/H Form C(3) (Rev. 01/2017) Destroy previous editions.