Remittance Form

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    REPRODUCE LOCALLY, include form number and edition date on all reproductions
    FORM APPROVED - OMB NO. 0581-0198
     

    UNITED STATES DEPARTMENT OF AGRICULTURE

    AGRICULTURAL MARKETING SERVICE

    LAMB PROMOTION, RESEARCH and INFORMATION BOARD REMITTANCE REPORT

    Information is required by 7CFR 1280.223. Failure to report can result in a fine. Information provided in this report is held confidential under 7CFR 1280.277.

    Note: 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 05861-0196. The time is required to complete this information is estimated to average 1 hour 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, gender, religion, age, disability, sexual orientation, political beliefs, maritial or family status, parental status, or protected genetic information. (Not all prohibited basis 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 ad TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 72905964 (voice and TDD). USDA is an equal opportunity provider and employer.

    REPORT AND REMITTANCE OF AMOUNT COLLECTED AND DUE ON SHEEP AND LAMBS

    FOR THE PURPOSE OF THIS PROGRAM: A Lamb is defined as an ovine animal of any age, including ewes and rams.

  • NUMBER OF SHEEP OR LAMBS ASSESSED
    TOTAL POUNDS OF LIVE SHEEP OR LAMBS
    ASSESSMENT RATE PER POUND
    Total
     
  • x $ .005
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  • TOTAL SHEEP OR LAMBS SLAUGHTERED (first handler fee, rate of $0.30 per head):
    Total Assessments x .02 - Late Payment
     
    x $ .30
    TOTAL ASSESSMENTS=
    * LATE PAYMENT=
    TOTAL REMITTANCE=
     
    You may be subject to late fees per the Act & Order
  • PENALTIES: You may, by law be fined up to $10,000, imprisoned up to five years or both for knowingly or willfully making false statements within this document (18 U.S.C 1001)
     
    CERTIFICATION STATEMENT

    I declare under the penalties provided by law, that this report has been examined by me and to the best of my knowledge and belief is a true, correct, and complete report. I also certify that I am authorized to sign this report.

  • LS081 (08-03) (Destroy previous editions)