No Form Number Beef Monthly Report and Remittance for Cattle Purchased

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OMB 0581-0093

Beef Promotion and Research Board
A program designed to increase demand for beef

Information is required by (7 CFR 1260.201). Failure to report can result in a fine. Information is held confidential (7 CFR 1260.203).

MONTHLY REPORT AND REMITTANCE FOR ALL CATTLE PURCHASED OR MARKETED IN THE MONTH OF:
_______________________, _________.
I.D. NO:
COMPANY NAME:
CONTACT NAME:
STREET OR ROUTE:
CITY:

STATE:

COUNTY:

ZIP:

TELEPHONE NO.

This report and assessments must be remitted by the fifteenth day of the month following the month in which
the cattle were marketed. Late payments are subject to a 2% per month late payment charge.
Instructions: Please provide the following information on all cattle you or your company marketed by completing the following table:

CATTLE AND CALVES
State of Origin

Total Number of Head Marketed

TOTAL
Send report and
check payable to:

Number of Head NOT Assessed

Number of Head per State Assessed

-

=

-

=

-

=

-

=

-

=

-

=

-

=

-

=

-

=

-

=

-

=

-

=
TOTAL

TOTAL

x $1.00 / Head

Missouri Beef Merchandising Fund
Missouri Department of Agriculture
Post Office Box 630
Jefferson City, Missouri 65102

AMOUNT DUE

$

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

RESPONDING OFFICIAL'S NAME (PRINT)

TITLE (print)

SIGNATURE

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 0581-0093. The time required to complete this information collection
is estimated to average 1.8 minutes 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.

Beef Promotion and Research Board
A program designed to increase demand for beef

COMPLETING A MONTHLY REMITTANCE FORM
This form should be completed each month and should include all cattle purchased during the
previous month. You have until the 15th of the following month to send in the form and
money. (EXAMPLE: If you buy cattle in January the form and a check is due February 15).
MONTH

-- The month in which the cattle was purchased.

ID NO. -- Whatever number you use to file with the IRS (Federal Identification Number). Individuals should use their social security number.
COMPANY -- Company's name or, if you buy as an individual, your own name.
LATE CHARGE -- Failure to remit checkoff assessments by the due date will result in a late
payment charge of 2% per month, compounded monthly, until all amounts due are paid.
STATE OF ORIGIN -- The state where the cattle resided for at least 30 days prior to the time
they were bought or sold. If they came from another state within the last 30 days, write in the
abbreviation of that state. Otherwise, write the abbreviation for your state.
Example: If you buy cattle that have been in your state for only 20 days, the state of origin is the
state they came from, not your state.
TOTAL NUMBER OF HEAD MARKET

-- The total number of cattle you purchased.

NUMBER OF HEAD NOT ASSESSED -- Cattle for which you received a non-producer status
from, a brand inspection certificate showing collection of the checkoff within 10 days of the
transaction or cattle which you purchased from an auction market.
NUMBER OF HEAD ASSESSED PER STATE -- This is the number of animals on which you
collected checkoff dollars. It is the total number of animals marketed minus those not assessed.
TOTAL -- Total for the entire month. Just add each column.
AMOUNT DUE -- The number in this box is the amount due. Send your check along with the
white copy of this form to the:

MISSOURI BEEF MERCHANDISING FUND
MISSOURI DEPARTMENT OF AGRICULTURE
POST OFFICE BOX 630
JEFFERSON CITY, MISSOURI 65102

PENALTIES

-- You can be subject to two penalties:

a) a civil penalty of up to $5,500 per violation.
b) for fraudulent use of a government form a fine up to $10,000 and imprisonment up
to five years.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin,
sex, religion, age, disability, political beliefs, sexual orientation, or marital or family status. (Not all prohibitied bases 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 and 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 202-720-5964 (voice and TDD).
USDA is an equal opportunity provider and employer.