LP 81 Form

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

OMB N0. 0581-0093

_{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 §1280.227.

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 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.

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.

CHECK THE APPROPRIATE TRANSACTION(S): ^{NAME AND ADDRESS (Include street address or P.O. Box No., City, State, Zip Code)}

Live sheep or lambs purchased for slaughter

Exported sheep or lambs

Custom slaughter or direct marketing of sheep or lambs

_{Business Telephone Number (include area code): ( ) -}

ASSESSMENTS ON LIVE SHEEP OR LAMBS REMITTED DURING THE MONTH OF , 20_____

The report and assessments must be remitted (postmarked) by the 15th day of the month following the end of the collection period. Late Payments are subject to a 2 percent per month late payment charge.

NUMBER OF SHEEP OR LAMBS ASSESSED	TOTAL POUNDS OF LIVE SHEEP OR LAMBS	ASSESSMENT RATE PER POUND	TOTAL
		x $.007
		x $.007
		x $.007
		x $.007
		x $.007

TOTAL SHEEP OR LAMBS SOLD/SLAUGHTERED (first handler fee, rate of $0.42 per head):

_{x $.42}

*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=}

_{If the assessment is less than the total pounds of live weight sold, explain:}

TOTAL REMITTANCE=

Send this report and a check for the total remittance to:

American Lamb Board

Street

City, State, and Zip

_{CERTIFICATION STATEMENT}

PENALTIES: You may, by law be fined up to $10,000, imprisoned up to 5 years, or both for knowingly or willfully making false statements within this document (18 U.S.C. §1001).

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.

RESPONDING OFFICIAL'S NAME AND TITLE (Print)

_SIGNATURE

DATE

LP-81 (Expiration Date XX/XX/XXXX) See reverse for burden/non-discrimination statement

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW., Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.

LP-81 (Expiration Date XX/XX/XXXX)