Ethanol Producer Report Form - South Dakota Page 2
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1
2PRODUCTION PAYMENT CALCULATION (CONT.)
25
25
$
Total payment due for this reporting period – Subtract Line 24 from Line 23
SIGNATURE
I,______________________________________________, for the alcohol producer named on the front of this report, do hereby certify under penalty of perjury that I
have examined this claim, and to the best of my knowledge and belief, it is correct and complete. I further certify that all ethanol has been produced from cereal grain at
a refinery facility located within South Dakota and that such ethanol has been denatured and meets the 99% purity requirement.
Signature
Title
Date
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