F/H Form B (982) Hazelnut Mktng. Bd.--Shellers Application for Lett

OMB No. 0581-0178

HAZELNUT MARKETING BOARD

21595-A Dolores Way NE

Aurora, OR 97002-9738

Tel: (503) 678-6823; Fax: (503) 678-6825

SHELLER’S APPLICATION FOR LETTER OF AUTHORITY

TO THE HAZELNUT MARKETING BOARD:

An application is hereby made for designation as an authorized sheller of hazelnuts with the privilege of receiving restricted hazelnuts for shelling purposes as provided in § 982.52 (a) of Marketing Order No. 982, regulating the handling of hazelnuts grown in Oregon and Washington (Order). In consideration of the granting of this application, the undersigned agrees:

1. To use such restricted hazelnuts as that may be received for no purpose other than shelling;

2. To dispose of or deliver such restricted hazelnuts as unshelled hazelnuts to no one other than another authorized sheller;

3. To comply fully with all laws and regulations applicable to the shelling of hazelnuts; and

4. To make such reports, certified to the Board and to the Secretary as to their correctness, as the Board may require.

The undersigned also agrees to ensure that all kernels are properly inspected and certified in accordance with sections 982.46 and 982.101 of the Order.

The undersigned now holds all state, county and municipal licenses required by law and is complying with and will continue to comply with all federal, state and municipal laws applicable to hazelnut shelling operations.

Our shelling operations are conducted at ___________________________________________________. We have been shelling hazelnuts at the above location(s) for the past ______ years. We have a maximum productive capacity of _________ pounds of shelled hazelnuts per day.

Dated _____________________ ____________________________________________________

Name of Applicant

Title _______________________ By _________________________________________________

SHELLER’S LETTER OF AUTHORITY

(Invalid unless signed by an authorized Agent of the Hazelnut Marketing Board)

The foregoing application is hereby granted, and the applicant is designated as an authorized sheller to receive and shell restricted hazelnuts pursuant to the provisions of §982.52(a) of Marketing Order No. 982. This authorization applies only to the location or locations given in the foregoing application, is effective from ________________, and remains in effect only until the end of the current fiscal year.

Dated _____________________ By _________________________________________________

Authorized Agent, Hazelnut Marketing Board

No sheller’s application may be approved unless a completed application form has been received and authorized (7 U.S.C. 608(d), 7 CFR 982.52(a) and 7 CFR 982.452(a)).

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