F/H form 6 (982) Hazelnuts Crop Received, Disposed of or on Hand

OMB No. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823

Fax: (503) 678-6825

20___ CROP HAZELNUTS RECEIVED, DISPOSED OF, OR ON HAND

AS OF _____________________, 20___

RECEIPTS

1. Orchard-run (20___ crop) received from growers (dry weight)

(Include own production, if any) ……………………………………………… ________________ lbs

2. Received from other handlers a. merchantable………………. ________________ lbs

(Not declared by handler to the Board.) b. orchard-run………………… ________________ lbs

Note – list names of handlers and c. small size…………………… ________________ lbs

amounts received on back of this form d. culls………………………… ________________ lbs

3. TOTAL RECEIPTS OF 20___ CROP………………………………………… ________________ lbs

DISPOSITION

4. Declared shipped from production area to domestic market …………………. ________________ lbs

5. Restricted product sold in export………………………………………………. ________________ lbs

6. Merchantable product declared as restricted and shelled…………………….... ________________ lbs

7. Ungraded product declared as restricted and shelled………………………….. ________________ lbs

8. Merchantable Equivalent of kernels produced and certified………………….. ________________ lbs

9. Sales made to other handlers a. merchantable………………. ________________ lbs

(Not declared to Board) b. orchard-run………………… ________________ lbs

Note – list names of handlers and c. shelling stock………………. ________________ lbs

amounts delivered on back of this form d. culls………………………… ________________ lbs

10. Other Use (describe) _________________________________________ ________________ lbs

(describe)_________________________________________ ________________ lbs

11. Culls of no value disposed of…………………………………………………. ________________ lbs

12. TOTAL DISPOSITION BY JUNE 30, 20___…..…………..………….…….. ________________ lbs

ON HAND

13. Declared merchantable………………………………………………………… ________________ lbs

14. Undeclared merchantable……………………………………………………… ________________ lbs

15. Ungraded restricted……………………………………gross weight…………. ________________ lbs

16. Merchantable restricted………………………………………………………… ________________ lbs

17. Orchard-run……………………………………………………………………. ________________ lbs

18. Shelling stock………………………………………………………………….. ________________ lbs

19. Merchantable equivalent of kernels on hand in process not reported to Board ________________ lbs

20. Culls……………………………………………………………………………. ________________ lbs

21. TOTAL INSHELL HAZELNUTS on hand as of June 30, 20___………..…….. ________________ lbs

22. TOTAL SHELLED HAZELNUTS on hand as of June 30, 20___….……..……. ________________ lbs

HANDLER___________________________________ By ________________________________________

This report is required by law (7 U.S.C. 608(d), 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 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.

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: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

F/H Form 6 (Rev. 01/2017) Destroy previous editions.