Form DPR-ENF-180/181 "Registrant's Report of Pesticide Sales in California" - California

What Is Form DPR-ENF-180/181?

This is a legal form that was released by the California Department of Pesticide Regulation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the California Department of Pesticide Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DPR-ENF-180/181 by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download Form DPR-ENF-180/181 "Registrant's Report of Pesticide Sales in California" - California

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STATE OF CALIFORNIA
FOR QUARTER ENDING
DEPARTMENT OF PESTICIDE REGULATION
MILL ASSESSMENT PROGRAM
DELINQUENT AFTER
P.O. BOX 4015, MAIL STOP 4A
SACRAMENTO, CALIFORNIA 95812-4015
DPR-ENF-180/181 (Rev. 07/15)
REGISTRANT'S REPORT OF PESTICIDE SALES IN CALIFORNIA
Firm Name and Address
Firm Number
California Food and Agricultural Code (FAC) section 12841 requires registrants to pay a quarterly assessment on ALL pesticides sold for use in
California. FAC section 12841.1 requires an additional assessment on agricultural and dual use pesticides, excluding pesticides labeled only for
home, industrial, and institutional use.
Instructions for completing this form:
- Complete this form in duplicate. Keep the copy for your records.
- The assessment is based on the price as shown on the invoice to your customers.
- Line one: Report the total dollar of sales of ALL pesticides, including home, industrial, and institutional use.
- Line two: Report the total dollar of sales of pesticides labeled for agricultural and dual use, excluding home, industrial, or institutional use only
pesticides.
- Line three through five: Subtotal - add penalty, if necessary, and total.
- Products labeled and sold "for manufacturing use only" are exempt from mill assessment.
- After completing the form, sign it and mail the original with proper remittance to the address shown below.
- If no sales were made during the quarter, mark 'NONE,' sign the form and return it to the address shown below.
- If you have questions, call the Mill Assessment Program Representative at (916) 445-4159 or email at millassessment@cdpr.ca.gov.
- Make check payable to: Cashier, Department of Pesticide Regulation.
Sign and return this form to:
CASHIER
DEPARTMENT OF PESTICIDE REGULATION
P.O. BOX 4015, MAIL STOP 4A
SACRAMENTO, CALIFORNIA 95812-4015
TOTAL ASSESSABLE PESTICIDE SALES - FOR USE IN CALIFORNIA
1. Total Dollar Sales of All Pesticides for Quarter:
$
$
X .02100 =
.02100 = 21.00 mills
$
2. Total Dollar Sales of Agricultural or Dual Use Pesticides for Quarter
$
X .00075 =
.00075 = .75 mills
$
3. Subtotal:
4. Penalty of 10% (ten percent) of amount due (if not mailed within one calendar month after end of quarter as
required by FAC section 12843):
$
5. Total amount submitted with this report:
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION CONTAINED IN THIS REPORT
IS TRUE, CORRECT, AND COMPLETE.
Print Name of Authorized Representative
Official Title
Date
Signature of Authorized Representative
Area Code and Telephone Number
Email
STATE OF CALIFORNIA
FOR QUARTER ENDING
DEPARTMENT OF PESTICIDE REGULATION
MILL ASSESSMENT PROGRAM
DELINQUENT AFTER
P.O. BOX 4015, MAIL STOP 4A
SACRAMENTO, CALIFORNIA 95812-4015
DPR-ENF-180/181 (Rev. 07/15)
REGISTRANT'S REPORT OF PESTICIDE SALES IN CALIFORNIA
Firm Name and Address
Firm Number
California Food and Agricultural Code (FAC) section 12841 requires registrants to pay a quarterly assessment on ALL pesticides sold for use in
California. FAC section 12841.1 requires an additional assessment on agricultural and dual use pesticides, excluding pesticides labeled only for
home, industrial, and institutional use.
Instructions for completing this form:
- Complete this form in duplicate. Keep the copy for your records.
- The assessment is based on the price as shown on the invoice to your customers.
- Line one: Report the total dollar of sales of ALL pesticides, including home, industrial, and institutional use.
- Line two: Report the total dollar of sales of pesticides labeled for agricultural and dual use, excluding home, industrial, or institutional use only
pesticides.
- Line three through five: Subtotal - add penalty, if necessary, and total.
- Products labeled and sold "for manufacturing use only" are exempt from mill assessment.
- After completing the form, sign it and mail the original with proper remittance to the address shown below.
- If no sales were made during the quarter, mark 'NONE,' sign the form and return it to the address shown below.
- If you have questions, call the Mill Assessment Program Representative at (916) 445-4159 or email at millassessment@cdpr.ca.gov.
- Make check payable to: Cashier, Department of Pesticide Regulation.
Sign and return this form to:
CASHIER
DEPARTMENT OF PESTICIDE REGULATION
P.O. BOX 4015, MAIL STOP 4A
SACRAMENTO, CALIFORNIA 95812-4015
TOTAL ASSESSABLE PESTICIDE SALES - FOR USE IN CALIFORNIA
1. Total Dollar Sales of All Pesticides for Quarter:
$
$
X .02100 =
.02100 = 21.00 mills
$
2. Total Dollar Sales of Agricultural or Dual Use Pesticides for Quarter
$
X .00075 =
.00075 = .75 mills
$
3. Subtotal:
4. Penalty of 10% (ten percent) of amount due (if not mailed within one calendar month after end of quarter as
required by FAC section 12843):
$
5. Total amount submitted with this report:
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION CONTAINED IN THIS REPORT
IS TRUE, CORRECT, AND COMPLETE.
Print Name of Authorized Representative
Official Title
Date
Signature of Authorized Representative
Area Code and Telephone Number
Email
STATE OF CALIFORNIA
FOR QUARTER ENDING
DEPARTMENT OF PESTICIDE REGULATION
MILL ASSESSMENT PROGRAM
DELINQUENT AFTER
P.O. BOX 4015, MAIL STOP 4A
SACRAMENTO, CALIFORNIA 95812-4015
DPR-ENF-181 (Rev. 07/15)
Registrant's Products
Firm Number
Important Instructions:
For each product listed, report total dollar value and total pounds (or gallons, if sold in liquid form) of product sold for use in California. If no
product sales were made, enter "None" or zero for product. Check Non-Ag box to indicate products labeled for home, industrial, or institutional
use only.
Registration No.
Brand Name
Product No.
Non-Ag
DOLLARS
QUANTITY
1
LBS
GAL
2
LBS
GAL
3
LBS
GAL
4
LBS
GAL
5
LBS
GAL
6
LBS
GAL
7
LBS
GAL
8
LBS
GAL
9
LBS
GAL
10
LBS
GAL
11
LBS
GAL
12
LBS
GAL
13
LBS
GAL
14
LBS
GAL
On each page, add numerical amounts for each column. For quantity column, add
QTY
Page Total:
numerical values of lbs/Gal together (Enter sum total on the last page).
Sum Total:
QTY
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