Soybean Promotion, Research and Consumer Information Program (SPARC)

Complete the form below

ORGANIZATION

Name *

Address 1 *

Address 2

City *

State *

Zipcode *

Business Telephone *

Required Number *

First Purchaser ID: FP12345

County *

I.D.Quarter *

ASSESSMENT 1

State of Origin *

Number of bushels purchased *

Number of bushels assessed *

Net market value of assessed bushels *

x 0.5% = $0.00

Average calculated price per bushel= 0.00

Assessment Totals

Total Assessments:

2% Collection Fee:

For first purchasers in Illinois (if filed by due date)

Late Payment:

2% mandatory late payment
(compounded monthly)

Total Remittance Due:

Certification Statement

Name *

Title *

I declare, under the penalties provided by law, that this report has been examined by me; and to the best of my knowledge and believe is a true, correct and complete report.

I agree