"Rice Refund Request Form" - Louisiana

Rice Refund Request Form is a legal document that was released by the Louisiana Department of Agriculture & Forestry - a government authority operating within Louisiana.

Form Details:

  • The latest edition currently provided by the Louisiana Department of Agriculture & Forestry;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Louisiana Department of Agriculture & Forestry.

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Download "Rice Refund Request Form" - Louisiana

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RICE REFUND REQUEST
Submit to:
Louisiana Department of Agriculture & Forestry
5825 Florida Blvd., Suite 1003
Baton Rouge, LA 70806
Name:
Address:
City, State:
Zip:
Phone: _________________________ Email: ______________________________
I am requesting a refund for assessments deducted from the attached rice settlement sales slips:
In accordance with La. R.S. 3:3534, Rice Promotion Assessments:
Amount
%
Refund
Date
Buyer/Settlement
Withheld
Share
Amount
In accordance with La. R.S. 3:3544, Rice Research Assessments:
Amount
%
Refund
Date
Buyer/Settlement
Withheld
Share
Amount
I certify the attached copy of sales slips are true and accurate copies and understand this documentation is used to
determine refund eligibility:
Signed
Date
Signed
Date
RICE REFUND REQUEST
Submit to:
Louisiana Department of Agriculture & Forestry
5825 Florida Blvd., Suite 1003
Baton Rouge, LA 70806
Name:
Address:
City, State:
Zip:
Phone: _________________________ Email: ______________________________
I am requesting a refund for assessments deducted from the attached rice settlement sales slips:
In accordance with La. R.S. 3:3534, Rice Promotion Assessments:
Amount
%
Refund
Date
Buyer/Settlement
Withheld
Share
Amount
In accordance with La. R.S. 3:3544, Rice Research Assessments:
Amount
%
Refund
Date
Buyer/Settlement
Withheld
Share
Amount
I certify the attached copy of sales slips are true and accurate copies and understand this documentation is used to
determine refund eligibility:
Signed
Date
Signed
Date