CWB 17 Request for Transfer of Reserve Credits

California Walnut Board OMB No. 0581-0178

101 Parkshore Drive, # 250 CWB Form #17

Folsom, CA 95630

Ph (916) 932-7070 Fax (916) 932-7071

REQUEST FOR TRANSFER OF RESERVE CREDITS

This report requesting the transfer of reserve credits is submitted in compliance with the requirements of the Federal Marketing Order No. 984, as amended. In executing this form, the handler respectively certifies to the California Walnut Board and to the U.S. Department of Agriculture as to the correctness and completeness of their statement.

Instructions: 1. Complete the information below.

2. The form must be signed by both handlers and submitted in triplicate.

3. Following approval, the California Walnut Board will send a copy to each handler.

In accordance with the provisions of Section 984.456(b) of Marketing Order No. 984, as amended, it is requested that ______________________ pounds (kernelweight) of reserve credits be transferred:

FROM: Handler __________________________________________________________

By ______________________________________________________________

Title ____________________________________________________________

Date ____________________________________________________________

TO: Handler __________________________________________________________

By ______________________________________________________________

Title _____________________________________________________________

Date ____________________________________________________________

CALIFORNIA WALNUT BOARD

The foregoing request is hereby approved, and the California Walnut Board records have been adjusted accordingly.

By ___________________________________________ Date ________________________

N

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 5 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.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

ote: No transfer of reserve credit will be approved by the California Walnut Board for either the receiving or transferring handler unless a completed form has been received. (7CFR 984.56 and 7CFR 984.456)

Rev. 04/09