CREAMERY LICENSE DIVISION ______(765) 494-8289 270 S. Russell Street, Rm. 1074 (765) 494-9346 – Fax West Lafayette, IN 47907-2042 www.ansc.purdue.edu/cld

May Assessment 20xx

The Creamery License Law provides for an assessment of 2.5 cents per hundred-weight for and 50 cents per pound of received as from Indiana producers on the total of such receipts for the month of May. All out of state milk and cream producer receipts shall be exempt from such fees. All milk producers of the State of Indiana shall pay this fee. It shall be deducted from their checks for the month of May production. The processor, receiving station, milk shipping station, milk factory, milk distributor, cheese factory, condensery, factory, other processing plant, person or person’s agent handling, receiving, buying or paying for milk or cream from producers, bargaining agent, or another plant shall charge 2.5 cents per hundred-weight back to the producer associations and cooperatives, the processor shall make this charge directly to the individual producer. If all or part of you assessment payment is to be made by your milk supplier agent, please indicate the name of the agent and the amount to be paid by that agent. Please complete the enclosed form showing the total milk and butterfat receipts from Indiana producers at your plant or station for the month of May 20xx. Make all checks payable to: CREAMERY LICENSE DIVISION and mail to:

Creamery License Division Christy Coon 270 S. Russell St., Rm. 1074 West Lafayette, IN 47907

Please mail appropriate check no later than June 30, 20xx. Sincerely,

Christy Coon Creamery License Manager 765.494.8289 [email protected] CREAMERY LICENSE DIVISION ______(765) 494-8289 270 S. Russell Street, Rm. 1074 (765) 494-9346 – Fax West Lafayette, IN 47907-2042 www.ansc.purdue.edu/cld

This report must be completed and returned to: Creamery License Division 270 S. Russell St., Rm. 1074 West Lafayette, IN 47907

Report of Milk and Butterfat Receipts for the month of May 2019 (All out-of-state receipts shall be exempt)

Name of Company: Address: City: State: Zip: Phone:

The following quantities of milk and/or cream were received by the above named plant during May 2018.

Lbs. of Milk @ $0.025/cwt $

Lbs. of Butterfat in cream @ $0.50/cwt $

Number of producers supplying milk during May 2019

Lbs. of milk for which supplier agent(s) will make payment

Name and address of supplier agent(s):

Make all checks payable to: CREAMERY LICENSE DIVISION and mail to: Creamery License Division Christy Coon 270 S. Russell St., Rm. 1074 West Lafayette, IN 47907

The above statements are correct to the best of my knowledge.

Signature: Date: