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 — supplement^'! 

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



19 ): 



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

 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 feedingstufTs as required by paragraph 1 of Chapter 226, Re- 

 vised 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 feedingstufTs. Registration fee is $15.00 for each feedingstufTs.) 



Address correspondence to: 



Attention Firm Name 



Street and No By .. 



Citv 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 labelled and otherwise in com- 

 pliance with 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 



