Fillable Printable Receiving Report Form - Ohio
Fillable Printable Receiving Report Form - Ohio
Receiving Report Form - Ohio
DAIRY DIVISION
8995 East Main Street, Reynoldsburg, OH 43068-3399
Telephone: (614) 466-5550 Fax: (614) 728-2652
www.agri.ohio.gov/dairy Email: d
airy@agri.ohio.gov
RECEIVING REPO RT
DAIRY-3500-006.pdf (4/7/2010) Page 1 of 3
Milk Plant Name:
Month and Year:
License Number:
Pounds
Dairy Products
Received Utilized
Fee
Factor
Assessed Pounds
(Pounds x Factor) / 100
1 Grade A Raw Milk
1.00
2 Manufacture Raw Milk
0.50
3 Liquid Whey or Condensed Whey*
0.10
4
Dairy Products, Ice Cream Mix or
Cream*
1.00
5
Condensed Dairy Products (Not
including condensed whey)*
3.00
6 Dairy Powders Utilized*
11.62**
Total Assessed Pounds
* Product not derived from Grade A Raw Milk or Manufacture Raw Milk
** Dry Powder Blenders 5.00 onl y
I hereby certify that this information is correct to the best of my know ledge.
Signature Title Date
Email Address
DAIRY-3500-006.pdf (4/7/2010) Page 2 of 3
INSTRUCTIONS FOR COMPLETING THE
“DAIRY PRODUCTS RECEIV E D OR UTILIZED PER MONTH”
FORM
Milk Plant Name: Print the name of your facility.
Month and Year: Print the month and year utilized for this report.
License Number: Print the milk plant license number.
Line 1: Enter the total pounds received of GRADE A RAW MILK for the reporting month.
Line 2: Enter the total pounds received of MANUFACTURE RA W MILK for the reporting month.
Line 3: Enter the total pounds received of LIQUID WHEY or CONDE NSED WHEY purchased by your facility for
the reporting month.
NOTE: Do not include liquid whey or condensed whey derived from Grade A or manufacture raw milk
received at your plant.
Line 4: Use either the "Received" column or the "Utilized" column; not both.
In the received column, enter the total pounds of DAIRY PRODUCTS or CREAM received.
In the utilized column, enter the total pounds of ICE CREAM MIX purchased and utilized by your facility
for the reporting month.
NOTE: Do not include dairy products, cream or ice cream mix derived from Grade A or manufacture raw
milk received at your plant.
Line 5: Enter the total pounds received of CONDENSED DAIRY PRODUCTS purchased for your facility for the
reporting month.
NOTE: Do not include condensed dairy products derived from Grade A or manufacture raw milk received
at your plant.
Line 6: Enter the total pounds purchased of DAIRY POWDERS utilized by your facility for the reporting month.
NOTE: Do not include dairy powders derived from Grade A or manufacture raw milk received at your
plant.
Additionally, processors receiving only dry powder for the purpose of blending shall have their dairy
inspection fee calculated using a fee factor of 5.0.
DAIRY INSPECTION FEE SCHEDULE
July 1, 2009
On April 9, 2009, the Milk Sanitation Board voted to revise the dairy inspection fee schedule as outlined
below. The change of the dairy inspection fee schedule shall be effective with the July 1, 2009 invoices
whose payment is due August 20, 2009. The change shall be implemented as follows:
A. Dairy inspection fees shall be apportioned to all milk processors and frozen dessert manufacturers
licensed by the Director and located in the state of Ohio.
B. Flat rate inspection fees and minimum level fees shall be collected in addition to the apportioned
dairy inspection fees.
C. Milk Haulers shall list with the Director each milk tank or conveyance he owns or operates by
June 30 of each calendar year. The milk hauler shall pay an annual flat rate dairy inspection fee of
$15.00 for each tank or conveyance. Invoices shall be calculated and mailed no later than July 15
of each calendar year. The total annual dairy inspection fee shall be paid on or before August 30
of the year in which they are invoiced.
D. Receiving stations and transfer stations shall pay a flat rate dairy inspection fee of $180.00
annually. Invoices shall be calculated and mailed no later than July 1 of each calendar year. The
annual dairy inspection fee shall be paid on or before August 30 of year in which they are
invoiced.
E. The monthly apportioned dairy inspection fee shall be $135,000.
All corrections, adjustments or re-calculations shall be apportioned in the succeeding month(s)
from the current billing period. Apportioned dairy inspection fees shall be paid to the Treasurer,
State of Ohio, on the twentieth (20
th
) day of the month following the date of the invoice. Failure
to pay dairy inspection fees shall be cause for license revocation.
F. Milk processors and frozen desse rt manufacturers shall submit on forms provided by the Ohio
Department of Agriculture the pounds of Grade A raw milk received, the pounds of manufacture
raw milk received and the pounds of dairy products received or utilized during the previous
month. The receiving reports shall be received by the Ohio Department of Agriculture, Dairy
Division no later than the twentieth (20
th
) day of each month.
Milk processors and frozen desse rt manufacturers shall pay monthly a dairy inspection fee
apportioned by:
a) The hundredweight of Grade A raw milk received times the fee factor of 1.0; plus
b) The hundredweight of manufacture raw milk received times the fee factor of 0.5; plus
c) The hundredweight of liquid or condensed whey received times the fee factor of 0.1; plus
d) The hundredweight of dairy products, ice cream mix or cream received or utilized times
the fee factor of 1.0; plus
e) The hundredweight of condensed dairy products (not including condensed whey)
received times the fee factor of 3.0; plus
f) The hundredweight of dairy powders utilized times the fee factor of 11.62; provided,
processors which are dry powder blenders only shall be calculated at a fee factor of 5.0.
g) The minimum apportioned dairy inspection fee shall be $25.00.
DAIRY-3500-006.pdf (4/7/2010) Page 3 of 3
