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Fertilizer And Lime Tonnage Report Form - Rhode Island Department Of Environmental Management

RHODE ISLAND DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

DIVISION OF AGRICULTURE

Annual Tonnage Report of Commercial Fertilizer and Agricultural Liming Materials

For the Period July 1, 2013 Thru June 30, 2014

The following is a report of the above stated material offered for sale by us in accordance with certified statements made

in the application for registration and as also required under the Rhode Island Commercial Fertilizer Law and the Rhode

Island Agricultural Liming Materials Law, and a permit is hereby granted to the Director of the Department of

Environmental Management of Rhode Island, or his authorized designee, to verify this report, if he considers it necessary,

by the examination of the books and records of the registrant

Firm Name:_______________________________________________________________________________

Address:__________________________________________________________________________________

City:_____________________________________________State:___Zip:_____________________________

E-Mail:____________________________________Web Page address:_______________________________

Complete all information below with the number of tons of each brand and grade of fertilizer, fertilizer material or

agricultural liming material sold during the annual period ending June 30

, 2014. Tonnage fees are assessed at the rate

of $0.15 per ton. (No tonnage fees are assessed on agricultural liming materials, however, the form must still be

completed and returned to the RI Division of Agriculture.) Aggregate fees of less than one dollar are waived

GRADE

TOTAL TONS

BAGGED

BULK

LIQUID

DELIVERD TO CITY/TOWN

(For additional space attach 81/2 x 11 sheet)

The total number of tons sold_______________________Total amount enclosed_________________________

I hereby certify, under the penalties of perjury that the above statement is a full and correct report of the tonnage of each

grade or brand of fertilizer, fertilizer material or agricultural liming material sold in the state of Rhode Island for the annual

period ending June 30

2014. The tonnage report and tonnage fee shall be due on or before July 30

following the

close on the annual period.

Official Submitting this report_______________________________________________________

Date_____________________________

Mail to: Rhode Island Division of Agriculture 235 Promenade Street, Providence, RI 02908

Fertilizer And Lime Tonnage Report Form - Rhode Island Department Of Environmental Management