CB-1 Cotton Board Collecting Handler Report (paper version)

Collecting Handler R.eport

PLEASE TYPE
OR PRINT
RETURN TO

FOR COTTON RESEARCH AND PROMOTION ASSESSMENTS COLLECTED
COLLtCTING HANDl.rR NUM8rR
(If oot known - Conoo OOard will lurn1Shl

COTTON BOARD
P.O. Box 2121
Memphis, Tenn. 38101-2121

INSTRUCTIONS: Mail Original and Duplicate Copy of Report to Collon Board together with full
remittance. Prepare Separate Report for each G,n and each Crop Year To Be Mailed within 10days
after End of each Month During which Cotton was Handled.

GIN NUMBER

l.

NAME Of l'flOCIOCll
- WHOM=� wau COUKTT0

DATE
COLLECTED

DATE Of LAS I REPORl

MAILING ADO�ESS OF P!lOOUCTR
FROM WHOM ASSESSMENTS WERE COLLECTED

2
3.
4.

s.
6.
7

••
9.

10.
It.

12.

13.
14.

u.
16.
17.

1&.

IMPORTANT

IF COLLECTING HANDLER REPORT COVERS
MORE THAN ONE GIN-ALSO USE RECAP REPORT

CROP YEAR COT10N

MONTH COVERED BY THIS REPORT

STATE

I COUNTY

HIIMUN

FIRM NAMf & MAILING AOORE'>S Sheet! Nombe, (o, PO Bo,)
CITY. STATE 8. ZIP CODE

BALES LISTED WERE GINNED AT:

NAME AND ADDRESS OF GIN

OMB No. 0581-0093

Total Bales This Gin
Toti.II Assetsment This Gin

WAS PRODUCED
TOTAL

ASSE�NTI

0,

COU.KTtO

IIALES

.

8/C-

1111

CERTIFICATION: l certi�t that the above information is true and correct to the best of my knowledge and the attached remittance represents the tote
required assessments per bole an all cotton handled during the reporting period on wh1Ch I was required to collect the assessments.
(DAT!)

(>Rl(:;lNAI -·· VlHtTF-RfTURN 10 (OfTON
BOARD t)t_JPlK".AlE -PINI\-RETURN IO COHON
80AR0 H?1P1_1(AH: ... (ANA�Y ... RE1AJN r::()R FllES

CB-1 Expiration Date XX/XX/XXXX

Th1> repor1 " reqv,red by low (7 U S.C 2101)

Fci!ure lo rep::.-or1 con 1esuh 1n a penalty of not more !hon � UX)O fm er.1ch 1:u!h
ottense whKh �hall ocetue ,o lhe Uniied Stolm and moy be recovert......-J in o C:IYII
u,it ho-...,-,ht t->v tl,o I l n i1M (,tnt.J"><

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 05810093. 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.
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