"Application for Alabama Wholesale Egg Dealer's Permit" - Alabama

Application for Alabama Wholesale Egg Dealer's Permit is a legal document that was released by the Alabama Department of Agriculture and Industries - a government authority operating within Alabama.

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Download "Application for Alabama Wholesale Egg Dealer's Permit" - Alabama

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1445 Federal Drive ● Montgomery, Alabama 36107-1123
Rick Pate
APPLICATION FOR ALABAMA WHOLESALE
Commissioner
EGG DEALER’S PERMIT
October 1, 2020 through September 30, 2021
The undersigned hereby applies for a permit as dealer in the sale of shell eggs in accordance with Alabama laws. In filing this application for a
permit, the undersigned expressly agrees to comply with the Alabama Egg Laws and all regulations promulgated for the enforcement thereof by the
Commissioner of Agriculture and Industries. All persons engaged in the sale of eggs by a dealer to a retailer or to another wholesaler are considered a
wholesaler and is, therefore, required to obtain a Wholesale Egg Dealer’s Permit.
$5
The permit is renewable for
on or before October 1 of each year.
Mail completed and signed application(s) to:
AL Dept. of Agriculture & Industries
Food Safety Section, Room 220
1445 Federal Drive
Montgomery, AL 36107-1123
*Applications for RENEWALS received bearing a postmark later than November 1, 2020 will be
delinquent and will require a late penalty of fifteen percent (.75 cents) for each establishment per each
permit. This late fee does not apply to FIRST-TIME APPLICANTS.
Please Print Legibly
Name_____________________________________________
County____________________
DEALER /COMPANY to be Issued Permit
Telephone # ____________________
(Area Code & Number)
PHYSICAL ________________________________________________________________________
ADDRESS:
_______________________________________________________________________
(0$,/ $' ' 5 (6 6
______________________________________________________________
MAIL PERMIT TO NAME___________________________________________________________
& MAILING ADDRESS:
_________________________________________________________B
______________________________
_________________________
___________________
DATE
SIGNATURE OF APPLICANT
TITLE
WE DO NOT ACCEPT CASH
--------------------------------------- DO NOT WRITE BELOW THIS LINE ----------------------------------
Money Order #_____________________________ Check Amt $__________ CK#_____________
Date: ____________________________________
Permit Fee $______$5.00_________________
Approved By: _____________________________
15% Penalty*__________________________
(DUE IF POSTMARKED AFTER NOV 1)
PERMIT NUMBER_________________________
TOTAL_______________________________
www.agi.alabama.gov ● Phone 1-800-642-7761
“We provide employment & services without discrimination.”
1445 Federal Drive ● Montgomery, Alabama 36107-1123
Rick Pate
APPLICATION FOR ALABAMA WHOLESALE
Commissioner
EGG DEALER’S PERMIT
October 1, 2020 through September 30, 2021
The undersigned hereby applies for a permit as dealer in the sale of shell eggs in accordance with Alabama laws. In filing this application for a
permit, the undersigned expressly agrees to comply with the Alabama Egg Laws and all regulations promulgated for the enforcement thereof by the
Commissioner of Agriculture and Industries. All persons engaged in the sale of eggs by a dealer to a retailer or to another wholesaler are considered a
wholesaler and is, therefore, required to obtain a Wholesale Egg Dealer’s Permit.
$5
The permit is renewable for
on or before October 1 of each year.
Mail completed and signed application(s) to:
AL Dept. of Agriculture & Industries
Food Safety Section, Room 220
1445 Federal Drive
Montgomery, AL 36107-1123
*Applications for RENEWALS received bearing a postmark later than November 1, 2020 will be
delinquent and will require a late penalty of fifteen percent (.75 cents) for each establishment per each
permit. This late fee does not apply to FIRST-TIME APPLICANTS.
Please Print Legibly
Name_____________________________________________
County____________________
DEALER /COMPANY to be Issued Permit
Telephone # ____________________
(Area Code & Number)
PHYSICAL ________________________________________________________________________
ADDRESS:
_______________________________________________________________________
(0$,/ $' ' 5 (6 6
______________________________________________________________
MAIL PERMIT TO NAME___________________________________________________________
& MAILING ADDRESS:
_________________________________________________________B
______________________________
_________________________
___________________
DATE
SIGNATURE OF APPLICANT
TITLE
WE DO NOT ACCEPT CASH
--------------------------------------- DO NOT WRITE BELOW THIS LINE ----------------------------------
Money Order #_____________________________ Check Amt $__________ CK#_____________
Date: ____________________________________
Permit Fee $______$5.00_________________
Approved By: _____________________________
15% Penalty*__________________________
(DUE IF POSTMARKED AFTER NOV 1)
PERMIT NUMBER_________________________
TOTAL_______________________________
www.agi.alabama.gov ● Phone 1-800-642-7761
“We provide employment & services without discrimination.”