12:77:03:01Form of claim for refund.

A claim for refund shall contain the following information: (1) Claimant's name; (2) His state of residence; (3) His post office address; (4) The claim period; (5) Number of cows milked; (6) Products sold; (7) Date of sales; (8) Names of buyers; (9) Gross value of sale; (10) Amount of American Dairy Association deduction; (11) Total value of product sold; (12) Total assessment deducted; (13) Amount of refund claimed; (14) A perjury statement; (15) The date of application; and (16) The claimant's signature in ink.

Source: SL 1975, ch 16, § 1; 12 SDR 128, 12 SDR 154, effective July 1, 1986.