Form FS-3 Quarterly Feed Tonnage Report - Hawaii

Form FS-3 is a Hawaii Department of Agriculture form also known as the "Quarterly Feed Tonnage Report". The latest edition of the form was released in April 1, 2010 and is available for digital filing.

Download a PDF version of the Form FS-3 down below or find it on Hawaii Department of Agriculture Forms website.

ADVERTISEMENT
FS-3
04/10
Please send more forms
STATE OF HAWAII
Additional forms can also be printed from our website
DEPARTMENT OF AGRICULTURE
www.hawaii.gov/hdoa/Info/forms
at:
COMMODITIES BRANCH
1851 Auiki Street
CONFIDENTIAL
Honolulu, Hawaii 96819-3100
QUARTERLY FEED TONNAGE REPORT
(See reverse for instructions)
Name of firm
Report for quarter ending: (circle one)
Address
MAR
JUNE
SEPT
DEC
20
City
State
ZIP
Ph:
Fax:
I certify that this report on animal feeds which are imported for use or distribution, or manufactured for use or distribution in Hawaii is
an accurate and truthful accounting to the best of my knowledge.
Signature
Title
Print Name
Date Filed
COLUMN A
COLUMN B
COLUMN C
COLUMN D
Registration No.,
Brand Name of Commercial or Custom Mixed Feed
Commercial &
Toll Milled &
“Custom”, “Toll”,
or
Custom Mixed Feed
Other Feed
or “Other”
Identity of Toll Milled or Other Feed
TONS
TONS
Tons
Tons
TOTAL TONNAGE
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
$
DOA USE ONLY
Multiply total of Column C by $0.40
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
$
Multiply total of Column D by $0.20
Receipt No.: _______________________
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
$
Logged by: __________ Date __________
Add Inspection fees from Column C and D
Issued
$
When applicable, LATE PENALTY FEE of 10%
CM No.:_____________ Date __________
$
Bill No.: ____________ Date __________
TOTAL INSPECTION FEE TO BE PAID
FS-3
04/10
Please send more forms
STATE OF HAWAII
Additional forms can also be printed from our website
DEPARTMENT OF AGRICULTURE
www.hawaii.gov/hdoa/Info/forms
at:
COMMODITIES BRANCH
1851 Auiki Street
CONFIDENTIAL
Honolulu, Hawaii 96819-3100
QUARTERLY FEED TONNAGE REPORT
(See reverse for instructions)
Name of firm
Report for quarter ending: (circle one)
Address
MAR
JUNE
SEPT
DEC
20
City
State
ZIP
Ph:
Fax:
I certify that this report on animal feeds which are imported for use or distribution, or manufactured for use or distribution in Hawaii is
an accurate and truthful accounting to the best of my knowledge.
Signature
Title
Print Name
Date Filed
COLUMN A
COLUMN B
COLUMN C
COLUMN D
Registration No.,
Brand Name of Commercial or Custom Mixed Feed
Commercial &
Toll Milled &
“Custom”, “Toll”,
or
Custom Mixed Feed
Other Feed
or “Other”
Identity of Toll Milled or Other Feed
TONS
TONS
Tons
Tons
TOTAL TONNAGE
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
$
DOA USE ONLY
Multiply total of Column C by $0.40
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
$
Multiply total of Column D by $0.20
Receipt No.: _______________________
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8
$
Logged by: __________ Date __________
Add Inspection fees from Column C and D
Issued
$
When applicable, LATE PENALTY FEE of 10%
CM No.:_____________ Date __________
$
Bill No.: ____________ Date __________
TOTAL INSPECTION FEE TO BE PAID
FS-3 (reverse)
INSTRUCTIONS FOR COMPLETING QUARTERLY FEED TONNAGE REPORT (FS-3)
1.
Reports must be filed on a quarterly basis – first quarter report by April 30, second quarter by July 31, third quarter by
October 31 and fourth quarter by January 31. A late penalty fee of 10% shall be added to inspection fees, which have not
been paid within 30 days following the due date.
2.
The following must be reported:
a.
Feed sold by local manufacturers and distributors to feed stores and final users.
b.
Feed imported by feed stores for resale to final users.
c.
Feed imported by final users for their own use.
3.
DO NOT LIST FEED FOR DOGS, CATS AND HOUSEHOLD PETS OR WET GARBAGE.
4.
Tonnage may be reported to the nearest ton.
DEFINITIONS
COMMERCIAL FEED means either a “Commercial Mixed Feed” which is a mixture or blend of more than one feed ingredient or
a “Commercial Simple Feed” which consists of only one feed ingredient. These feeds are registered and are assessed an
inspection fee of 40 cents per ton.
CUSTOM MIXED FEED means a special commercial mixture, which is formulated by the manufacturer or processor in accor-
dance with the specific instructions of the final purchaser and contains feed material or materials wholly or partly supplied by
such manufacturer or processor. These feeds are not registered and are assessed an inspection fee of 40 cents per ton.
TOLL MILLED FEED means a special feed which is processed by the processor from materials entirely delivered by the owner
thereof or his authorized agent and in accordance with the specific instructions of such owner, and which is not distributed.
These feeds are not registered and are assessed an inspection fee of 20 cents per ton.
OTHER FEED means:
a.
Whole seeds unmixed or physically altered entire unmixed seeds.
b.
Hay, straw, stover, silage, cobs, husks and hulls when unground or when unmixed with other materials.
c.
Individual chemical compounds when not mixed with other materials.
d.
Unmixed feeding cane molasses, unmixed pineapple pulp, unmixed pineapple hay, and unmixed sugarcane hay.
These feeds are not registered and are assessed an inspection fee of 20 cents per ton.
FINAL USER means a ranch, feedlot, consumer, or agricultural cooperative that purchases feed for its own use.
COMPLETING FORM FS-3
1.
Fill in your firm’s name, address, city, state and zip code.
2.
Circle the month in which the quarter ends and fill in the appropriate year.
3.
Fill in your firm’s phone and fax numbers.
4.
Sign the form and fill in your title , printed name, and the date of the report filing.
5.
Commercial Feed: (a) Fill in registration number in column A. (This number can be obtained from form FS-2, Application
for Registration of Commercial Feeds or the current listing of Feeding Stuffs Registration) (b) List the brand name as
registered in column B. (c) List the total tonnage for the quarter in Column C.
6
Custom Mixed Feed: (a) Write “Custom” in Column A. (b) List the named identity utilized when billing buyers in
Column B. (c) List the total tonnage for the quarter in Column C.
7.
Toll Milled Feed: (a) Write “Toll” in column A. (b) List the named identity utilized when billing buyers in Column B.
(c) List the total tonnage for the quarter in Column D.
8.
Other Feed: (a) Write “Other” in Column A. (b) List the name or identity utilized when billing buyers in Column B.
(c) List the total tonnage for the quarter in Column D.
9.
Add Column C and add Column D and place total tonnage in the appropriate block at the bottom of each column.
10. Calculate the appropriate inspection fee for the total tonnage in Columns C and D and place in appropriate block.
11. Add the inspection fees for Column C and Column D and enter amount in “TOTAL INSPECTION FEE TO BE PAID”.
12. Make REMITTANCE payable to HAWAII DEPARTMENT OF AGRICULTURE.
13. A total inspection fee of less than $1.00 is waived but the Quarterly Feed Tonnage Report must still be filed.
14. For addition forms, check the box indicated at the top, or additional forms may be printed from our website at:
www.hawaii.gov/hdoa/Info/forms.
15. Mail form and payment to:
HAWAII DEPT. OF AGRICULTURE
COMMODITIES BRANCH
1851 Auiki Street
Honolulu, Hawaii 96819-3100

Download Form FS-3 Quarterly Feed Tonnage Report - Hawaii

978 times
Rate
4.7(4.7 / 5) 59 votes
ADVERTISEMENT
Page of 2