CIAB Form #1 Weekly Raw Product Report

W

CIAB

FORM #1

OMB # 0581-0177

Week Ending:

Final Report:

eekly Raw Product Report

C

herry Industry Administrative Board

P.O. Box 388, DeWitt, MI 48820-0388

Tel: 517/669-1070 Fax: 517/669-1260

Report receipts of fruit starting with the first week of harvest and pack and continue until the harvest is completed. The report is due in the CIAB office by close of business, Eastern Time, on Monday following each week of harvest. Indicate the Final Report when it is submitted.

Handler: Handler ID#

Address:

City, ST Zip:

Telephone No.:

RAW PRODUCT RECEIVED

By District of Production

WEEKLY PRODUCTION

Total of Fruit Received

YEAR to DATE

Total of Fruit Received

01 NW Michigan

02 WC Michigan

03 SW Michigan

04 New York

05 Oregon

06 Pennsylvania

07 Utah

08 Washington

09 Wisconsin

TOTAL RECEIPTS:

The undersigned hereby certifies to the CIAB and the Secretary of Agriculture that this is a true and correct report of product received by the Handler for the indicated period.

By:

Title:

Date:

(see other side for additional information)

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 0581-0177. The time required to complete this information collection is estimated to average 15 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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