Both the seller
and the buyer have the responsibility to have the $1 per head assessment
collected and remitted to the qualified state beef council. This
form is designed for the seller to use in private treaty sales.
Date_____________________________
Seller's Name_______________________________
Buyer's Name_______________________________
Address________________________________________
Address_________________________________________
City________________
State_______ Zip__________
City________________ State_______
Zip__________
Seller's Signature__________________________________
Buyer's Signature__________________________________
Total Number of
Cattle Sold________________x $1.00/head = $_______________________
Dale of Sale____________________________
Person remitting assessment
o Seller
o Buyer
State of origin
of cattle____________________
Brand Inspection Number (if applicable)________________________
Send Form and Remittance to: N. C. Cattlemen's Association, 2228 N. Main Street, Fuquay-Varina, NC 27526
Public reporting burden for this collection of information is estimated to average .08 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the form. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing the burden, to USDA, OIRM, Clearance Officer, Room 404-W, Washington, D.C. 20250. When replying refer to the OMB Number and Form Number in your letter.
OMB #0581-0093
Return original to state beef council, pink to seller, yellow to buyer.