Corn Assessment Refund Request Form PDF Details

Farmers who grow corn and are concerned about the accuracy of their yield assessment should request a refund. The form to request the refund is available on the Nebraska Department of Agriculture website. Farmers have until December 1st to submit a claim. In order to be eligible for a refund, farmers must have paid for an assessment and have evidence to support their claim. Corn yield assessments can be impacted by factors such as weather and pests, so it's important that farmers are confident in the results. More information about the refund process is available on the Nebraska Department of Agriculture website.

QuestionAnswer
Form NameCorn Assessment Refund Request Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescorn assessment, iowa corn checkoff refund form, mo assessment refund, missouri corn checkoff form

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STATE OF MISSOURI DEPARTMENT OF AGRICULTURE COMMODITY FUND PROGRAM

IDENTIFICATION NUMBER

________________________________________

DO NOT WRITE IN THIS SPACE

MISSOURI DEPARTMENT OF AGRICULTURE

CORN COMMODITY FUND

P.O. BOX 630

JEFFERSON CITY, MISSOURI 65102

573-751-5515

CORN ASSESSMENT REFUND REQUEST

IN ORDER TO QUALIFY FOR A CORN ASSESSMENT REFUND:

1.COMPLETE THE FOLLOWING INFORMATION AND ATTACH SETTLEMENT SHEETS WHICH VERIFY THE DATE OF SALE, NUMBER OF BUSHELS SOLD, AND THE AMOUNT OF CORN ASSESSMENT FEES DEDUCTED.

2.SUBMIT THIS CORN ASSESSMENT REFUND REQUEST FORM AND SETTLEMENT SHEETS TO THE MISSOURI DEPARTMENT OF AGRICULTURE WITHIN SIXTY (60) DAYS AFTER THE DEDUCTION IS MADE.

PRODUCER NAME

FED. TAX ID # OR SOCIAL SECURITY #

ADDRESS

CITY

STATE

ZIP

TELEPHONE NO.

FIRST PURCHASER NAME

ADDRESS

CITY

STATE

ZIP

TELEPHONE NO.

NUMBER OF SETTLEMENT SHEETS ATTACHED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

MONTH DEDUCTION MADE BY FIRST PURCHASER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL BUSHELS SOLD TO FIRST PURCHASER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL BUSHELS CLAIMED FOR REFUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AMOUNT CLAIMED FOR REFUND AT $.01 PER BUSHEL . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UNDER PENALTIES OF PERJURY, I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE INFORMATION CONTAINED ON THIS FORM AND THE ATTACHED SETTLEMENT SHEETS IS TRUE AND ACCURATE.

SIGNATURE

DATE

MO 350-0215 (7-09)