OMB No. 0581-0189

Exp. 1/31/2027. Destroy previous editions. 

Remit to: WASHINGTON STATE FRUIT COMMISSION

105 S. 18th Street, Suite 205

Yakima, WA 98901-2149

Phone: (509) 453-4837

Fax: (509) 453-4880 PROCESSED PEAR ASSESSMENT REPORT

Firm ___________________________________ Prepared by ________________________________________________

Address ___________________________________ Signature ________________________________________________

City ___________________________________ Date ________________________________________________

State ____________ Zip Code ____________ Crop Year ________________________________________________

Name of Processors or Firms to 

whom fruit was sold

Tons Culls Sold 

for $ or Loss

Tons Culls Tons Graded Assessment Owing

Summer/Fall Canned Pears $_________ per ton

(Refer to Rate Sheet for Per Ton Assessment

Total Tons Reported Total Paid: $

TERMS: § 927.123. Payments received more than 45 days after the date on which they are due shall be considered delinquent and subject to a late payment charge of $25.00 or 2 percent of the total due, whichever is greater. 

Payments received more than 60 days after the date on which they are due shall be subject to 1 1⁄2 percent interest charge per month, until final payment is made, and interest shall be applied to the total unpaid balance, including the 

late payment charge and any accumulated interest.

Enclosed Check No. ________________________

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control 

number. The valid OMB control number for this information collection is OMB 0581-0189. The time required to complete this information collection is estimated to average 45 minutes per response, 

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
OMB No. 0581-0189

Exp. 1/31/2027. Destroy previous editions. 

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions 

participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, 

disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity 

conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible 

Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made 

available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at 

http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy 

of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 

Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.