LS-46 Soybean Report & Remittance--Amount Collected & Due on S

SPARC LS-46
REPORODUCE LOCALLY, Include form number and edition date on all reproduction.
FORM APPROVED-OMB No. 0581-0093
NOTE: Information is required by 7 CFR 1220.223. Failure to report can result in a fine. Information is held
U.S. DEPARTMENT OF AGRICULTURE
confidential (7CFR 1220.243)
AGRICULTURAL MARKETING SERVICE

SOYBEAN PROMOTION,
RESEARCH AND CONSUMER
INFORMATION PROGRAM
(SPARC)
A program of promotion, research and consumer information
designed to strengthen, expand and develop new foreign and
domestic markets for soybeans and soybean products.

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
IMB control number for this information collection is 0581-0093. The time required to complete this information
collection is estimated to average 1 hour needed, and completing and reviewing the collection of information.
The Unites States Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on
race, color, national origin, sex, religion, age, disability, political benefits sexual orientation, or martial or family st
all prohibited bases apply to all programs.) Persons with disabilities who require alternate means for commun
program information (Braille, large print, audiotape, etc.) should contact the USDA’s TARGET center at (202)
(voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W
Building, 14th and Independence Avenue, SW, Washington. DC 20250-9410 or call (202) 720-5964 (voice a
USDA is an equal opportunity provider and employer

REPORT AND REMITTANCE OF AMOUNT COLLECTED AND DUE ON SOYBEANS PURCHASED
NAME AND ADDRESS (Include P.O. Box or Street, City, State and ZIP)

Required Number
I.D. Number
Country
Business Telephone (Include area code)

The report and assessments must be remitted (postmarked) by the last day of the month following
the end of the collection period. Late payments are subject to a 2% per month late payment charge.
Must be remitted by _____________.
The following is a report on soybeans purchased and the net market value paid for such purchase
from the period commencing _____________________ and ending _____________________.
STATE OF ORIGIN

NUMBER OF
BUSHELS
PURCHASED

NET MARKET VALUE
OF ASSESSED
BUSHELS

NUMBER OF
BUSHELS
ASSESSED

“Net market value” (quoted price plus or minus premiums or
discounts such as moisture and quality factors) is the total
dollars paid for assessed soybeans during the reporting
period.
RATE
x.005 =

$

x.005 =

$

x.005 =

$

x.005 =

$

x.005 =

*NOTE: If remitting assessments past due date, calculate the 2% mandatory late
payment (compounded monthly)

Total Assessments x.02 = Late Payment

TOTAL ASSESSMENTS =
*LATE PAYMENT =*
TOTAL REMITTANCE =

SEND THIS REPORT AND A CHECK IN THE TOTAL AMOUNT SHOWN ABOVE TO:

TOTAL

$
$
$
$

OFFICE USE ONLY

PENALITIES: 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,
Section 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.

NAME/TITLE (Print or Type)

LS-46 (07-00)

SIGNATURE

Destroy previous edition dated (05-00).

DATE