Form CIAB Form #5A CIAB Form #5A Inventory Reserve Summary

REPRODUCE LOCALLY. Include form number and date on all reproductions. OMB No. 0581-0177

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CIAB

FORM 5A

Crop Year:

Original:

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NVENTORY RESERVE SUMMARY

Cherry Industry Administrative Board

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

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

This report is required of all Handlers holding inventory. Reports are due by the close of business Eastern Time on October 1 and May 31, and at any other time that a rotation of stock in inventory reserves is desired.

Handler: Handler ID#

Address, City, State, Zip:

Telephone No.:

WAREHOUSE CONVERTED LBS.

NAME	LOCATION	Raw Product Equivalent

For each warehouse listed on this form, a Form #5 B, Inventory Location Report, must be prepared and must

accompany the report.

By:

Title:

Date:

Page of

According the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number to 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 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.

CIAB Form 5A (Exp. X/XXXX) Destroy previous versions.