CWB 17 (984) CWB Request for Transfer of Reserve Credits

OMB No. 0581-0178

CALIFORNIA WALNUT BOARD

101 Parkshore Drive, Suite 250

Folsom, CA 95630

Ph (916) 932-7070; Fax (916) 932-7071

REQUEST FOR TRANSFER OF RESERVE CREDITS

This request for the transfer of reserve credits is submitted in compliance with the requirements of Marketing Order No. 984, as amended (Order). In executing this form, the handler respectively certifies to the California Walnut Board and the U.S. Department of Agriculture as to the correctness and completeness of their statement.

INSTRUCTIONS: 1. Complete the information below.

2. The form must be signed by both handlers and submitted in triplicate.

3. Following approval, the California Walnut Board will send a copy to each handler.

In accordance with the provisions of section 984.456(b) of the Order, it is requested that ___________ pounds (kernelweight) of reserve credits be transferred:

FROM: Handler __________________________________________________________

By ______________________________________________________________

Title _____________________________________________________________

Date _____________________________________________________________

TO: Handler __________________________________________________________

By ______________________________________________________________

Title _____________________________________________________________

Date _____________________________________________________________

CALIFORNIA WALNUT BOARD

The foregoing request is hereby approved, and the California Walnut Board records have been adjusted accordingly.

By ___________________________________________ Date ____________________________

Note: No transfer of reserve credit will be approved by the California Walnut Board for either the receiving or transferring handler unless a completed form has been received. (7 CFR 984.56, 7 CFR 984.456)

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 0581-0178. The time required to complete this information collection is estimated to average 5 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.

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.

CWB-17 (Exp. x/xxxx) Destroy previous editions.