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OMB No. 0581-NEW

	APPLICATION FOR REIMBURSEMENT OF ASSESSMENT

PROCESSED RASPBERRY PROMOTION, RESEARCH
AND INFORMATION ORDER 
(7 CFR PART 1208)







PLEASE READ THE INSTRUCTIONS AT BOTTOM OF APPLICATION
	BEFORE COMPLETION (PLEASE TYPE OR PRINT)




Name of Applicant
Title
Business Telephone No. (include Area code)



Name of Business

Tax ID# or Business ID#



Business Address
City
State				Zip


	_____________________________________	_____________________________________
	(Importer No. or Broker No.)			(Certificate of Exemption No.)

Name & Address of Producers from whom First Handler has received Domestic Raspberries for Processing OR
Port of Entry and Entry No. for Imported Processed Raspberries
Date that assessments were paid on Domestic Raspberries for Processing OR
Entry Date of Imported Processed Raspberries
Pounds of Domestic or Imported Processed Raspberries which assessments were paid
Amount of Assessment Collected















						Total amount of assessment collected to be reimbursed:        ____________________
	
	A reimbursement is hereby requested for the assessment collected by the U.S. Customs Service or paid by first handlers on processed raspberries that should have been exempted but was paid to the National Raspberry Council on the above-described processed raspberries.  I certify that the above information provided in this application for reimbursement is true and correct to the best of my knowledge and I have not previously applied for a reimbursement on the above listed processed raspberries.  I further certify that I am authorized to file this application on behalf of the aforementioned business. 1/



	_________________________________________	____________________________________________
	Name of Applicant (Print) 			Title



	X_________________________________________	____________________________________________
	Signature of Applicant				Date
INSTRUCTIONS

	RECEIPTS OR COPIES THEREOF MUST BE ATTACHED TO THIS APPLICATION
	Return to the National Raspberry Council
Street
City, State  Zip



Receipts or copies thereof, submitted with this application will not be returned.  Type or Print this application.  Attach additional pages if necessary.

















































RAS-AFR  (03/09)