"Application for Re-certification" - Delaware

Application for Re-certification is a legal document that was released by the Delaware Department of Agriculture - a government authority operating within Delaware.

Form Details:

  • Released on August 6, 2001;
  • The latest edition currently provided by the Delaware Department of Agriculture;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Agriculture.

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Download "Application for Re-certification" - Delaware

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State of Delaware
Telephone
(302) 698-4500
Department of Agriculture
DE Only
(800) 282-8685
Pesticide Compliance
Fax
(302) 697-4483
2320 S. DuPont Hwy., Dover, DE 19901
Application for Re-Certification
Change of Address:
Certification Number:
Applicator Type:
Category:
1A
Agricultural Plant
7A
General Pest Control
1B
Agricultural Animal
7B
Wood Destroying Pest Control
1C
Fumigation of Soil & Ag. Comm.
7C
Fumigation Pest Control (non-ag)
02
Forest
7D
Wood Preservatives
03
Ornamental & Turf
7E
Institutional & Maintenance
04
Seed Treatment
7F
Cooling Tower
5A
Aquatic
7G
Miscellaneous
5B
Anti-fouling Paint
08
Public Health
5C
Mosquito
09
Regulatory
06
Right-of-Way
10
Demonstration and Research
Current Employer:
Company Name
Address
City
State
Zip
Home Phone
Work Phone
I,
, hereby apply for re-certification as a Pesticide
Applicator in accordance with provisions of 3 Del C., Part II, Chapter 12, Section 1215-1223.
Signature
Date
NEW!!!
NEW!!!
NEW!!!
NEW!!!
CHECK/MONEY ORDER – FEE $30.00
CREDIT CARD – FEE $30.00
Visa
Mastercard
Discover
Billing Name:
Credit Card Billing
Make Check or Money Order
Address:
Payable to:
City/State/Zip:
CVC#
Credit Card Number:
Delaware Department of
/
Expiration Date:
Month
Year
Agriculture
Authorization:
Government agency employees who apply or supervise the application of pesticides are exempt
from the fee requirement if pesticide use is related to official duties.
Document No. 65-01-06/01/08/06
State of Delaware
Telephone
(302) 698-4500
Department of Agriculture
DE Only
(800) 282-8685
Pesticide Compliance
Fax
(302) 697-4483
2320 S. DuPont Hwy., Dover, DE 19901
Application for Re-Certification
Change of Address:
Certification Number:
Applicator Type:
Category:
1A
Agricultural Plant
7A
General Pest Control
1B
Agricultural Animal
7B
Wood Destroying Pest Control
1C
Fumigation of Soil & Ag. Comm.
7C
Fumigation Pest Control (non-ag)
02
Forest
7D
Wood Preservatives
03
Ornamental & Turf
7E
Institutional & Maintenance
04
Seed Treatment
7F
Cooling Tower
5A
Aquatic
7G
Miscellaneous
5B
Anti-fouling Paint
08
Public Health
5C
Mosquito
09
Regulatory
06
Right-of-Way
10
Demonstration and Research
Current Employer:
Company Name
Address
City
State
Zip
Home Phone
Work Phone
I,
, hereby apply for re-certification as a Pesticide
Applicator in accordance with provisions of 3 Del C., Part II, Chapter 12, Section 1215-1223.
Signature
Date
NEW!!!
NEW!!!
NEW!!!
NEW!!!
CHECK/MONEY ORDER – FEE $30.00
CREDIT CARD – FEE $30.00
Visa
Mastercard
Discover
Billing Name:
Credit Card Billing
Make Check or Money Order
Address:
Payable to:
City/State/Zip:
CVC#
Credit Card Number:
Delaware Department of
/
Expiration Date:
Month
Year
Agriculture
Authorization:
Government agency employees who apply or supervise the application of pesticides are exempt
from the fee requirement if pesticide use is related to official duties.
Document No. 65-01-06/01/08/06