F/H Form 5 (982) Hazelnuts Rept to Marketing Board of Handler Carry

OMB No. 0581-0178

HAZELNUT MARKETING BOARD This report is due

21595-A Dolores Way NE in the Board office

Aurora, OR 97002-9738 on or before

Tel: (503) 678-6823 July 15, 20___.

Fax: (503) 678-6825

REPORT TO HAZELNUT MARKETING BOARD OF HANDLER CARRYOVER

ON __________________________

City and State _________________________

The undersigned certifies to the Hazelnut Marketing Board (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 that were being held on June 30, 20___.

MERCHANTABLE

Pounds	Size	Variety	Location (mark an X)		Obligation Status (mark an X)
			Within Production Area1	Outside Production Area2	Declared (2)	Undeclared

¹ Held in the name of the handler, whether or not sold. ² Previously reported by the Board.

RESTRICTED

Pounds	Size	Variety	Classification (mark an X)
			Merchantable	Ungraded (Net Credited Wt.)

In addition to the hazelnuts listed above, there were held on _________________, 20___, __________ pounds of ungraded hazelnuts that will be carried over undeclared. There were _________ pounds of shelled hazelnuts on hand, which have already been reported to the Board on F/H Form 1(c).

Firm or Individual ________________________________ 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 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.

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 5 (Exp. x/xxxx) Destroy previous editions.