Complete the form below
First Purchaser ID: FP12345
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

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