QUARTERLY CORN ASSESSMENT REMITTANCE REPORT by HC12032508258

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									                  QUARTERLY CORN PROMOTION REMITTANCE REPORT

                          FOR QUARTER ENDING: June 30, _______________

       Handler is subject to penalty and interest for non-payment of promotion within 30 days of the
                                       end of each quarterly period.

                                                          INSTRUCTIONS
Please complete all items on this form even if you did not purchase corn during the quarter. Please mail this
form along with your check (if applicable) for the corn promotion fees collected to:

                         NORTH DAKOTA CORN UTILIZATION COUNCIL
                               1411 32nd STREET SOUTH, STE 2
                                   FARGO, ND 58103-6304
Please keep a copy of this form for your files. This report and your check (if applicable) must be received
within 30 days after the end of the quarter to avoid penalty. A postage paid envelope is enclosed. If you
have any questions concerning this form, please write to the address above or call 1-800-657-8007 or (701)
364-2250.

Company Name

Mailing Address

City/State/Zip

DESIGNATED HANDLER CERTIFICATE NUMBER

List other Locations that are included on this report:


                                                         PROMOTION COMPUTATION

TOTAL BUSHELS OF CORN PURCHASED THIS QUARTER
TOTAL VALUE OF CORN PURCHASED THIS QUARTER                                     $
PROMOTION RATE                                                                X             .0025
PROMOTION FEES COLLECTED (Value x .0025)                                       =



      FAILURE TO REPORT OR ANY FALISIFICATION CONSTITUTES A CLASS B
    MISDEMEANOR AND IS PUNISHABLE IN ANY COURT IN THE STATE OF NORTH.

                                                         DAKOTA.
                                                            CERTIFICATION: I certify that the above information is true
           FOR OFFICE USE ONLY                                and correct to the best of my knowledge and is in accordance with
                                                              the provisions of the ND Corn Utilization Council.
 AMT RECEIVED
                                                              Signature
 CK #                                                         Title
                                                               Business Phone #
 Date Received
                                                              Date

								
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