WAREHOUSE RECEIPT ON HANDLER-OWNED COMMODITY
This report shall be filed with the Grain Warehouse Section at the end of the business day each time a handler-owned (collateral) warehouse receipt is issued. Please submit the examiner's copy of the Warehouse Receipt and a copy of your complete combined daily position record before issuance of the warehouse receipt and after issuance of the warehouse receipt.
| Date: | State Code Number: |
| Handler: | |
| Warehouse Receipt Number: | |
| Commodity: | |
| Bushels Receipted: | |
| Report Prepared By: | Title: |