Fillable Annual Feed Tonnage Estimation Adjustment/Verification (Arizona)

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Annual Feed Tonnage Estimation Adjustment/Verification (Arizona)

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Arizona Department of Agriculture (ADA)
Central Licensing Section
1688 W. Adams
Phoenix, AZ 85007
Phone: (602) 542-3578 Fax: (602) 542-0466
Reporting Quarter: ___________ through ___________
A. Your Company chose to Estimate tonnage sales for the prior year. You are now required to report and pay fees for the
actual tonnage you distributed in the State of Arizona, by completing this form.
D. Finally, Sign form and submit these forms, with payment of the fee amount calculated on Page 2.
B. First fill out the "ESTIMATION DETAILS OF MATERIAL" section for each quarter below and sum up each Grand Total.
July-Sept
WHOLE TONS
BAGS BULK TOTAL
Dairy Cattle Supplements D
GENERAL INSTRUCTIONS :
ESTIMATION DETAIL OF FEEDS AND MATERIALS
For the Purpose of Reporting the Actual TONNAGE ESTIMATED in Last Year's "ESTIMATE OF SALES" Report
C. Next, complete the "CALCULATIONS INSTRUCTIONS" at the bottom of page 2 of this form.
Page 1
Beef Cattle Feeds A
Beef Cattle Supplements B
Dairy Cattle Feeds C
Oct-Dec
WHOLE TONS
BAGS BULK TOTAL
Mineral Feed/Supplement H
Calf Feeds & Supplements E
Fish Feeds F
Horse Feeds G
Rabbit Feeds L
Mixed Grains I
Pet Foods J
Poultry Feeds/Supplement K
Wild Bird/Pigeon Feeds P
Sheep & Goats Feeds M
Swine Feeds/Supplements N
Vitamin Feeds/Supplements O
Cotton Products T
Alfafa Products Q
Animal By-Products R
Beet Pulp S
Molasses Products X
Cottonseed Products U
Cottonseed, Whole Ammoniated V
Grain By-Products W
Oil Seed Meal (not cottonseed) Z
Non-protein Nitrogen Products Y
Ratites DD
Recycled Animal Waste Products AA
Salt BB
Screenings CC
Miscellaneous MM
Other (specify)
Other (specify
Other (specify)
Third Quarter GRAND TOTAL (whole tons only) . . . . . .
Other (specify)
Other (specify
Other (specify)
Forth Quarter GRAND TOTAL (whole tons only) . . . . . .
Company Name:___________________________________
Year:_______
Plant Address :___________________________________
_
Company Div: ___________________________________
Year:_______
Annual Feed Tonnage Estimation Adjustment/Verification
For ADA/ESD Use Only
Check # ____________________________
Check Date _________________________
Check Amount _______________________
Date Received ______________________
Line #______________________________
Dairy Cattle Supplements D
Beef Cattle Feeds A
Beef Cattle Supplements B
Dairy Cattle Feeds C
Mineral Feed/Supplement H
Calf Feeds & Supplements E
Fish Feeds F
Horse Feeds G
Rabbit Feeds L
Mixed Grains I
Pet Foods J
Poultry Feeds/Supplement K
Wild Bird/Pigeon Feeds P
Sheep & Goats Feeds M
Swine Feeds/Supplements N
Vitamin Feeds/Supplements O
Cotton Products T
Alfafa Products Q
Animal By-Products R
Beet Pulp S
Molasses Products X
Cottonseed Products U
Cottonseed, Whole Ammoniated V
Grain By-Products W
Oil Seed Meal (not cottonseed) Z
Non-protein Nitrogen Products Y
Ratites DD
Recycled Animal Waste Products AA
Salt BB
Screenings CC
Miscellaneous MM
Print Form
Arizona Department of Agriculture (ADA)
Central Licensing Section
1688 W. Adams
Phoenix, AZ 85007
Phone: (602) 542-3578 Fax: (602) 542-0466
Annual Feed Tonnage Estimation Adjustment/Verification
Reporting Quarter: _________ through ___________
3. Subtract $8.00 (previously paid amount) on line #2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Multiply amount on line #1 by fee rate of $0.20
Jan-Mar
WHOLE TONS
BAGS BULK TOTAL
CALCULATIONS INSTRUCTIONS :
ESTIMATION DETAIL OF FEEDS AND MATERIALS
4. If line #3 is $0.00 or less no fee is due, just submit this report.
Page 2
Apr-Jun
WHOLE TONS
BAGS BULK TOTAL
Other (specify)
Other (specify
Other (specify)
First Quarter GRAND TOTAL (whole tons only) . . . . . .
Other (specify)
Other (specify
Other (specify)
Second Quarter GRAND TOTAL (whole tons only) . . . . . .
Signature Title Date
The information provided is complete and accurate to the best of my knowledge.
Enclose payment, if applicable.
=
= $
= $ - 8.00
Year:_____ Year:_____
Dairy Cattle Supplements D
Beef Cattle Feeds A
Beef Cattle Supplements B
Dairy Cattle Feeds C
Mineral Feed/Supplement H
Calf Feeds & Supplements E
Fish Feeds F
Horse Feeds G
Rabbit Feeds L
Mixed Grains I
Pet Foods J
Poultry Feeds/Supplement K
Wild Bird/Pigeon Feeds P
Sheep & Goats Feeds M
Swine Feeds/Supplements N
Vitamin Feeds/Supplements O
Cotton Products T
Alfafa Products Q
Animal By-Products R
Beet Pulp S
Molasses Products X
Cottonseed Products U
Cottonseed, Whole Ammoniated V
Grain By-Products W
Oil Seed Meal (not cottonseed) Z
Non-protein Nitrogen Products Y
Ratites DD
Recycled Animal Waste Products AA
Salt BB
Screenings CC
Miscellaneous MM
Dairy Cattle Supplements D
Beef Cattle Feeds A
Beef Cattle Supplements B
Dairy Cattle Feeds C
Mineral Feed/Supplement H
Calf Feeds & Supplements E
Fish Feeds F
Horse Feeds G
Rabbit Feeds L
Mixed Grains I
Pet Foods J
Poultry Feeds/Supplement K
Wild Bird/Pigeon Feeds P
Sheep & Goats Feeds M
Swine Feeds/Supplements N
Vitamin Feeds/Supplements O
Cotton Products T
Alfafa Products Q
Animal By-Products R
Beet Pulp S
Molasses Products X
Cottonseed Products U
Cottonseed, Whole Ammoniated V
Grain By-Products W
Oil Seed Meal (not cottonseed) Z
Non-protein Nitrogen Products Y
Ratites DD
Recycled Animal Waste Products AA
Salt BB
Screenings CC
Miscellaneous MM
= $
1. Add the "GRAND TOTALS" of all four Quarters and enter total on this line.
TOTAL TONNAGE for the YEAR:
TOTAL Fee Due for TONNAGE:
Pay This Amount:
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Annual Feed Tonnage Estimation AdjustmentVerification (Arizona)

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Completed 20 July 2020

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