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DO NOT WRITE IN THIS BOX STANDARD MILK ASSIGNMENT FORM Contract No. Date Entered MILK HANDLER Date To Dairy Marketing Services P. O. Box 4844 Syracuse NY 13221-4844 Attn Producer Payments You are hereby authorized and directed to deduct monthly from any sums which may become due and owing me for milk sold under the provisions of my contract with your association. SELECT ONLY ONE 1 the sum of Dollars per month OF THE THREE 2 percent of gross amoun.

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