"Report of Grain Dealers Guaranty Fund Assessments" - South Carolina

Report of Grain Dealers Guaranty Fund Assessments is a legal document that was released by the South Carolina Department of Agriculture - a government authority operating within South Carolina.

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Download "Report of Grain Dealers Guaranty Fund Assessments" - South Carolina

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SOUTH CAROLINA DEPARTMENT OF AGRICULTURE
P.O. Box 11280
Columbia, South Carolina 29211-1280
Report of Grain Dealers Guaranty Fund Assessments
License Number:
_______________________________
FOR OFFICE USE ONLY
Receipt No. ______________________
C -
Account Number:
___________________________
Check Name: ____________________
Grain Dealer Name: _______________________________
Check No. _______________________
Address:
_______________________________
Check Amt: _____________________
City, ST Zip:
_______________________________
Fund No.
4159
Telephone:
_______________________________
Email:
_______________________________
Reporting Period: From: ________________ To: ________________
Assessment of 1 cent ($ .01) per bushel must be imposed on all grain handled by grain dealers licensed under Chapter
41 of Title 46 other than grain for which a prior grain dealer has already paid the assessment. The assessment must be
reported and remitted to the South Carolina Department of Agriculture by the grain dealer on or before the fifteenth
th
(15
) day of the month immediately following the month in which the grain was delivered to the grain dealer. If such
grain dealer has received quantities of grain subject to assessments totaling less than fifty dollars ($50) in any calendar
month, the assessments may be reported and remitted with the following month’s return. All assessments shall be
remitted at least once every three months. If no assessment is due, please state so and file your report.
Beginning Weight
Ending Weight Ticket
X $ .01 =
Number of Bushels
Ticket Number
Number
Assessment Amount
$
$
CHANGE OF CONTACT INFORMATION
CERTIFICATION: I certify that this report has been examined by
me and is to the best of my knowledge and belief a true and
complete report, made in good faith, for the period stated.
__________________________________________________
___________________________________________
__________________________________________________
Signature
__________________________________________________
___________________________________________
Title
Date
You may return this form and remittance to:
SOUTH CAROLINA DEPARTMENT OF AGRICULTURE
Attention: Grain Dealers Guaranty Fund Assessment
PO BOX 11280
COLUMBIA, SC 29211-1280
http://www.kellysolutions.com/sc/assessments/
OR you may pay your Grain Dealer Assessments online at:
Additional forms may be obtained at
www.agriculture.sc.gov
and click on FORMS link.
SOUTH CAROLINA DEPARTMENT OF AGRICULTURE
P.O. Box 11280
Columbia, South Carolina 29211-1280
Report of Grain Dealers Guaranty Fund Assessments
License Number:
_______________________________
FOR OFFICE USE ONLY
Receipt No. ______________________
C -
Account Number:
___________________________
Check Name: ____________________
Grain Dealer Name: _______________________________
Check No. _______________________
Address:
_______________________________
Check Amt: _____________________
City, ST Zip:
_______________________________
Fund No.
4159
Telephone:
_______________________________
Email:
_______________________________
Reporting Period: From: ________________ To: ________________
Assessment of 1 cent ($ .01) per bushel must be imposed on all grain handled by grain dealers licensed under Chapter
41 of Title 46 other than grain for which a prior grain dealer has already paid the assessment. The assessment must be
reported and remitted to the South Carolina Department of Agriculture by the grain dealer on or before the fifteenth
th
(15
) day of the month immediately following the month in which the grain was delivered to the grain dealer. If such
grain dealer has received quantities of grain subject to assessments totaling less than fifty dollars ($50) in any calendar
month, the assessments may be reported and remitted with the following month’s return. All assessments shall be
remitted at least once every three months. If no assessment is due, please state so and file your report.
Beginning Weight
Ending Weight Ticket
X $ .01 =
Number of Bushels
Ticket Number
Number
Assessment Amount
$
$
CHANGE OF CONTACT INFORMATION
CERTIFICATION: I certify that this report has been examined by
me and is to the best of my knowledge and belief a true and
complete report, made in good faith, for the period stated.
__________________________________________________
___________________________________________
__________________________________________________
Signature
__________________________________________________
___________________________________________
Title
Date
You may return this form and remittance to:
SOUTH CAROLINA DEPARTMENT OF AGRICULTURE
Attention: Grain Dealers Guaranty Fund Assessment
PO BOX 11280
COLUMBIA, SC 29211-1280
http://www.kellysolutions.com/sc/assessments/
OR you may pay your Grain Dealer Assessments online at:
Additional forms may be obtained at
www.agriculture.sc.gov
and click on FORMS link.