927-Processed Pear Assessment Report

OMB No. 0581-0189

Remit To: WASHINGTON STATE FRUIT COMMISSION
105 S. 18th Street, Suite 205

PROCESSED PEAR ASSESSMENT REPORT

Yakima, WA 98901-2149
Phone: (509) 453-4837
Fax: (509) 453-4880
Firm

Prepared by

Address

Signature

City
State

________________

Zip Code ________________

Name of Processors or Firms
to whom fruit was sold

TOTAL TONS REPORTED:

Tons Culls Sold
for $ or Less

______________

Tons
Culls

______________

Date

____________________

Crop Year

____________________

Tons
Graded

______________

Assessment Owing
Summer/Fall Canned Pears $_________ per ton
(Refer to Rate Sheet for Per Ton Assessment)

TOTAL PAID: $ ________________

TERMS: § 927.123. Payments received more than 45 days after the date on which they are due shall be considered delinquent and subject to a late payment charge of $25.00 or 2 percent of the total due, whichever is greater. Payments received more
than 60 days after the date on which they are due shall be subject to 1 1/2 percent interest charge per month, until final payment is made, and interest shall be applied to the total unpaid balance, including the late payment charge and any accumulated
interest.
ENCLOSED CHECK # ______________
Please make additions or corrections as needed. Keep a copy for your records. QUESTIONS? Call ____________________ at _____________________.

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 0581-0189. The time required to complete this information collection is estimated to average 45 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.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual
orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program (Not all prohibited 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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800)795-3272 (voice) or (202)720-6382 (TDD). USDA is an equal opportunity provider
and employer.

Rev. 7/10. Destroy previous editions.