F/H Form 5 Hazelnuts Rept to Marketing Board of Handler Carryover

HAZELNUT MARKETING BOARD F/H Form 5

21595 A Dolores Way NE OMB No. 0581-0178 Aurora, OR 97002-9738

REPORT TO HAZELNUT MARKETING BOARD OF HANDLER CARRYOVER

ON

City and State_____________________

The undersigned certifies to the Hazelnut Marketing Board and to the Secretary of Agriculture that the following is a true and complete report, to the best of his knowledge and belief, of all unshelled hazelnuts which were being held on _________________ .

MERCHANTABLE

Location (x) Obligation Status (x)

Pounds	Size	Variety	Within Production Area (1)	Outside Production Area (1)	Declared (2)	Undeclared

(1) Held in the name of the handler, whether or not sold. (2) Reported previously by the Board.

RESTRICTED

Classification (x)

Pounds	Size	Variety	Merchantable	Ungraded (Net Credited Wt.)

In addition to the hazelnuts listed above, there were held on June 30, 2006, __________ pounds of ungraded hazelnuts which will be carried over undeclared. There were _________ pounds of shelled hazelnuts on hand which have already been reported to the Hazelnut Marketing Board on Form F/H 1 (c).

Firm or Individual_______________________ By _________________________________

THIS REPORT IS DUE IN THE OFFICES OF THE HAZELNUT MARKETING BOARD ON OR BEFORE JULY 15, 2006.

This report is required by law (7 U.S.C. 608(d), and 7 CFR 982.66 and 7 CFR 982.466). Failure to report can result in a fine of not less than $50 or more than $5,000 for each such violation and each day during which such violation continues shall be deemed a separate violation.

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 20 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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.