CIAB 6 Grower Diversion Application & Tart Cherry Orchard Map

CHERRY INDUSTRY ADMINISTRATIVE BOARD
GROWER DIVERSION APPLICATION
Crop Year 20

OMB No. 0581-0177

To divert cherries in your orchard for Crop Year 20__, this form must be filed at the CIAB office
no later than April 15, 20 . Along with this application, new and/or updated orchard maps for
the diverted blocks must also be submitted.
Name of Grower:
Address:
City:
Phone number: ( )
Email:

Grower #:
Cell number: ( )

State

Zip

This section must be completed. (Indicate all appropriate responses.)
A.

B.
C.

I have carefully reviewed the orchard maps sent to me by CIAB after January
20__ and there are NO changes to any of those blocks represented by those printouts.
I certify those printouts are a true and accurate representation of my current orchard
blocks.
Attached are __________ _ revised orchard maps. The rest are the same
Attached are _
new orchard maps.
(Number of maps)

I agree by participating in this diversion program that I will abide by the rules and regulations
hereby established by the Board for diversion.
AUTHORIZATION FOR RELEASE OF PRODUCTION INFORMATION TO YOUR INSURANCE CARRIER
By marking this box, I authorize the CIAB to release to my crop insurance carrier
(e.g. Greenstone, FSA…) my production numbers for crop year(s)
. I
recognize that this sharing will streamline the reporting of this information to the insurance
carrier. This authorization shall continue until revoked by me in writing.
Signature:

Dated:

Return by April 15, 20_____ to:
Cherry Industry Administrative Board
12800 Escanaba Drive, Suite A
P.O. Box 388
DeWitt, MI 48820-0388

Phone: (517) 669-1070 Toll Free: (888) 639-2422
Fax: (517) 669-1260

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 05810177. The time required to complete this information collection is estimated to average 10 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.

CIAB Form 6 (Exp. 1/31/2024) Destroy previous versions.

CHERRY INDUSTRY ADMINISTRATIVE BOARD

OMB No. 0581-0177

TART CHERRY ORCHARD MAP

GROWER NAME:
ADDRESS:
BLOCK NAME:
Township:
__________Section #:
Lat.
Row 1, Tree 1
Point 2
Point 3
Point 4
Point 5
Point 6
Point 7
Point 8

Long.
___Ε
___Ε
___Ε
___Ε
___Ε
___Ε
___Ε
___Ε

___’
___’
___’
___’
___’
___’
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___’

BLOCK LOCATION:

___” / ___Ε
___” / ___Ε
___” / ___Ε
___” / ___Ε
___” / ___Ε
___” / ___Ε
___” / ___Ε
___” / ___Ε

CIAB #:
CITY:

PHONE:
STATE:
ZIP:
COUNTY:
__________ T: _____ R: _____ S: _____(Example: T2N, R1W, S12)

GPS Info, Optional and if Available

___’
___’
___’
___’
___’
___’
___’
___’

___”
___”
___”
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NEAREST CROSSROADS: ____________________
LOCATION DIRECTIONS:

and __________________________

GENERAL INFORMATION ABOUT THIS BLOCK OF CHERRIES
ACRES: ____ . __

SPACING: ___ Ν x ___ Ν

EST. OF LIVE TREES REMAINING: ___ __ %
ROW NO. 1 IS ON THE 9 North

9 South

9 East

VARIETY:9 Montmorency 9 Balaton 9
Meteor (optional)
9 Other

9 West SIDE OF THE FIELD.

PLEASE NOTE: PLEASE MAP THE BLOCK AS IT WAS ORIGINALLY PLANTED.
ROW TREES IN
NO. ROW
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

YEAR
PLANTED

ROW TREES IN
NO. ROW
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

YEAR
PLANTED

ROW TREES IN
NO. ROW

YEAR
PLANTED

41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60

IF THE BLOCK IS LARGER THAN 60 ROWS, USE ANOTHER MAP FOR THE CONTINUATION AND INDICATE
THAT THE SECOND MAP IS A CONTINUATION OF THE FIRST. ATTACH OR DRAW MAP(S) THAT SHOWS
BLOCK LOCATION USING SECTIONS, TOWNS, ROADS, and/or OTHER IMPORTANT LANDMARKS SO THAT
THE BLOCK CAN BE EASILY FOUND.
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT MAPPING OF THE ORCHARD TO WHICH IT
APPLIES.

Grower Signature

CIAB Form 6 (Exp. 1/31/2024) Destroy previous versions.

Date:

OMB No. 0581-0177

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 6 (Exp. 1/31/2024) Destroy previous versions.