New Hampshire 

 APPLICATION FOR REGISTRATION OF COMMERCIAL 



FEEDINGSTUFFS 



No. 



Date 



To the Commissioner of Agriculture, State Dept. of Agriculture, Concord, N. H.: 



The undersigned hereby makes application for registration — reregistration — supple- 

 mental registration of the following commercial feeding stuffs (for the period ending 

 December 31, 19 ): 



(List products to be reregistered under heading REREGISTRATIONS. List under heading 

 SUPPLEMENTAL those products added during the year.) 



Attached are product data sheets which have affixed thereto a label to be used on, 

 or attached to the containers of feeding stuffs as required by paragraph 1 of Chapter 226, 

 Revised Laws of N. H., Stock Foods Law. I hereby certify that the label or labels contain 

 the information required by the law. 



(Enclosed is in the amount of $ covering the 



registration fee for feeding stuffs. Registration fee is $15.00 for each feeding stuffs.) 

 Address correspondence to: 



Attention Firm Name " 



Street and No By 



City and State Title 



CERTIFICATE OF REGISTRATION 



This certifies (that the registration fee has been paid and) that the above-listed 

 products are this day registered under the provisions of the New Hampshire Stock Foods 

 law, and the sale is authorized when sold, offered or exposed for sale when labeled and 

 other-wise in compliance with the law, until cancelled for cause (for the period beginning 

 with the actual date of registration and continuing until December 31, unless the registra- 

 tion of any feed or feeds are cancelled). 



NEW HAMPSHIRE DEPARTMENT OF AGRICULTURE 



Commissioner 

 Date 



