New Hamoshire 



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 — 

 supplemental 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 provision 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 con- 

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

 cancelled). 



NEW HAMPSHIRE DEPARTMENT OF AGRICULTURE 



Commissioner 



Date 



11 



