New Hampshire 

 APPLICATION FOR REGISTRATION OF COMMERCIAL 



FEEDINCSTUFFS 



No. 

 Date 



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



The undersigned hereby makes application for registration — reregistration — supplemental 

 registration of the following commercial feedingstuffs (for the period ending December 31, 

 19 ) : 



(List products to be reregistered under heading RERECISTRATIONS. 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 at- 

 tached to the containers of feedingstuffs 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 in- 

 formation required by the law. 



(Enclosed is in the amount of $ covering the reg- 

 istration fee for feedingstuffs. Registration fee is $15.00 for each feedingstuffs.) 



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 provision of the New Hampshire Stock Foods law, and the 

 sale is authorized when sold, offered or exposed for sale when labeled and otherwise in com- 

 pliance vyith the law, until cancelled for cause (for the period beginning with the actual date of 

 registration and continuing until December 31, unless the registration of any feed or feeds are 



cancelled) . 



NEW HAMPSHIRE DEPARTMENT OF AGRICULTURE 



Commissioner 



Date 



