APC Form 5 Inshell Pecans Exported to Mexico for Shelling & Returne

OMB No. 0581-0291

American Pecan Council

P. O. Box 100398

Fort Worth, Texas 76185 (817) 916-0020

[email protected]

YEAR-END INVENTORY REPORT

APC Form 5 - Instructions

This report is submitted pursuant to 7 CFR 986.77 and 986.78 and is subject to audit verification by the American Pecan Council pursuant to 7 CFR 986.79. The completed form and assessments due must be delivered to the American Pecan Council no later than , --.

Please note: If completing the form electronically, you need only insert data in the blank WHITE cells. Once the information is entered, the column totals will be calculated automatically. If completing the form by hand, please calculate totals on the form manually.

The following are instructions for completing Form 5 – Year-End Inventory Report Date Completed: Enter the date the form is being completed.

FISCAL Year: Enter the FISCAL Year being reported upon

Pecans in Inventory and Handled Thought-out the Year:

1. In the top section of the form, enter the total weight of inshell remaining in inventory, broken down by type (i.e. Improved, Natives and Substandard), as well as how much of the inventory is committed/ contracted, but not shipped, for both export and domestic commitments. The “Total Pounds” figure includes all inshell in inventory REGARDLESS OF COUNTRY OF ORIGIN.

2. In the second section of the form, enter the total amount of Shelled Meats remaining in inventory, as well as what is committed/contracted, but not shipped, for both export and domestic commitments, REGARDLESS OF COUNTRY OF ORIGIN, whether improved, native or substandard.

3. Enter the breakdown of the Shelled Meats remaining in inventory by halves, pieces and work in process (WIP). The total of the three must equal the total Shelled Meat figure. Enter how much of the Shelled Meats inventory has been contracted/committed, but not shipped, for both export and domestic commitments.

4. If completing by hand, total the pounds of inshell inventory and the inshell equivalent of shelled inventory in the third section. Shelled meats are converted to inshell by multiplying shelled weight by 2.

5. In the bottom section of the form, enter the total amount of U.S. Inshell handled throughout the year broken down by type (i.e. Improved, Native and Substandard). IN THIS SECTION, REPORT ONLY U.S. INSHELL HANDLED.

6. In the final column of the bottom section, enter any assessments paid prior to submitting this report. If completing by hand, calculate the remaining assessments due.

UPON COMPLETION: Read the Certification Statement at the bottom of the form and write/type the Handler/Company name. Then sign and date the form in the spaces provided and fax - (866) 232-0085; Email [email protected]. You can also submit the form through the electronic reporting portal at

pecanportal.com. Register at https://accounts.pecanportal.com/register.

§986.81 Confidential information: All reports and records submitted by handlers to the Council staff, 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 OMB 0581-0291. 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.

Form 5 (XXXX)

Report of Year-End Inventory - FORM 5

OMB No. 0581-0291

Handler Number: (office use)

INSHELL IN INVENTORY ON AUGUST 31
Type of Inshell	Total Pounds	Committed, not shipped - Export	Committed, not shipped - Domestic	Uncommitted
Improved				0.00
Natives/Seedlings				0.00
Substandard				0.00
Total Inshell	0.00	0.00	0.00	0.00

SHELLED MEATS IN INVENTORY ON AUGUST 31
Type		Total Pounds	Committed, not shipped - Export	Committed, not shipped - Domestic	Uncommitted
Total Shelled Meats					0.00
Breakdown of Total Meats/Work in Process	Halves				0.00
	Pieces				0.00
	WIP				0.00
Math Check (Must = 0)		0.00	0.00	0.00	0.00

TOTAL INVENTORY (INSHELL BASIS) ON AUGUST 31
Type	Total Pounds	Committed, not shipped - Export	Committed, not shipped - Domestic	Uncommitted
Total Inventory (Inshell + Shelled*)	0.00	0.00	0.00	0.00

*NOTE: Shelled Meats are converted to inshell using a yield of 50% (multiplying the shelled meats by '2'.) The form automatically makes this calculation

US PECANS HANDLED THROUGHOUT THE YEAR
Pecans	Total Pounds	Assessed Rate	Total Assessment Owed For the Fiscal Year**	Assessment Paid to Date
Improved		$0.01	$0.00
Natives/Seedlings		$0.00	$0.00
Substandard		$0.00	$0.00
TOTALS	0.00		$0.00	$0.00

** Total Pounds multiplied by Assessed Rate

Remaining Assessment Due $0.00

Handler/Company

Address

Signature ^Date

Certification Statement: 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. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

Form 5 (XXXX)