South Dakota Administrative Rules
Title 12 - Department of Agriculture
Article 12:77 - American dairy association
Chapter 12:77:03 - Claims for refund
Section 12:77:03:01 - Form of claim for refund

(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.