ACP-7 Producer Delivery Report

OMB No. 0581-0215

Federal Marketing Order 983 - Administrative Committee for Pistachios

Instructions – Producer Delivery Report

Crop Year: _

Submit to:

Administrative Committee for Pistachios

4938 East Yale Avenue, Suite 102 Fresno, California 93727

Phone: (559) 255-6480 Fax: (559) 255-6485
Email: [email protected]

Processor Name: Name of processor (handler).

Entity Name: Provide the entity 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. 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, 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 (may be different than the county the producer lives in). 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: The signature page is to be signed by an authorized representative of named handler verifying the accuracy of the producer delivery data. Submit the original signature page to the ACP with your Assessment Report and payment on or before the December 15^th postmark deadline.

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.

Producer Delivery Report .
Crop Year:				Read instructions before completing this report.
Processor Name:					Producer Deliveries (pounds)
Entity Name			*Authorized Voter Name (Individual, General Partner, Corporate Officer or Trustee)		County of Production	Open Inshell	Closed Shell	Shelling Stock	Total Lbs. Processed
Name:			Name:
Tax Identification Number:			Mailing Address:
	___ Sole Proprietorship
	___ Corporation		Telephone No.:
	___ Partnership		Fax No.:
	___ LLC		Email Address:
	___ Trust		Total Bearing Acres:
Name:			Name:
Tax Identification Number:			Mailing Address:
	___ Sole Proprietorship
	___ Corporation		Telephone No.:
	___ Partnership		Fax No.:
	___ LLC		Email Address:
	___ Trust		Total Bearing Acres:
Name:			Name:
Tax Identification Number:			Mailing Address:
	___ Sole Proprietorship
	___ Corporation		Telephone No.:
	___ Partnership		Fax No.:
	___ LLC		Email Address:
	___ Trust		Total Bearing Acres:
Name:			Name:
Tax Identification Number:			Mailing Address:
	___ Sole Proprietorship
	___ Corporation		Telephone No.:
	___ Partnership		Fax No.:
	___ LLC		Email Address:
	___ Trust		Total Bearing Acres:
			TOTALS - THIS PAGE ONLY

NOTE: Signature Page is separate and must be included with report page(s).

Producer Delivery Report

Signature Page

Crop Year: _

Processor Name

*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.

Name of Processor Representative	Title
Signature	Signature Date

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.

ACP-7 (Exp. XXXXXX. Destroy previous editions.)