Form Pt-3 - Potato Tax Shipper'S Report Page 2

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Detailed list of Railroad Shipments
Date of Shipment
Car Initial and Number
Loading Point
Name of Original Loader
Pounds
Subtotal
Detailed list of Truck Shipments
Date of Shipment
Destination
Loading Point
Name of Original Loader
Pounds
Subtotal
PT-3 Revised 09/2011
For assistance in completing this form, call (207) 624-9609

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