Form FDACS-14226 "Limited Annual Sales Certification" - Florida

Form FDACS-14226 or the "Limited Annual Sales Certification" is a form issued by the Florida Department of Agriculture and Consumer Services.

Download a fillable PDF version of the Form FDACS-14226 down below or find it on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-14226 "Limited Annual Sales Certification" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Food Safety
Bureau of Food and Meat Inspection
Attention: Records Section
LIMITED ANNUAL SALES CERTIFICATION
3125 Conner Boulevard C-26
Tallahassee, FL 32399-1620
(850) 245-5520
ADAM H. PUTNAM
COMMISSIONER
Business Name
Food Entity #
Owner Name
_____
Owner Address
Owner City, State, Zip
Email ______________________________________________ Phone _____________________________
Our records indicate that you are currently operating under limited sales permit type:
If you had gross food sales of $15,000 or more during the last twelve months or anticipate having more than
$15,000 in gross sales during the next twelve months, you do not qualify for a limited sales category.
If you did not have gross food sales of $15,000 or more during the last twelve months, you must sign and have
this form notarized to verify your limited sales status. Failure to sign and have this form notarized prior to renewal
will result in the non-limited sales fee charged for this firm type.
I,
(owner of business), by my signature below and notarized statement
affirm that my food business has gross food sales less than $15,000 in the preceding 12 months, and
furthermore, I do not anticipate gross food sales of $15,000 or more during the next 12 months.
Anyone making a false statement with the intent of misleading an agent of the Department of Agriculture
and Consumer Services shall be guilty of a misdemeanor in the second degree.
Print/Type Name
Phone
_
_
_
_
Signature of Owner or Principal
Date
The foregoing instrument was acknowledged before me, the undersigned authority, by
_________________________, to me well known or who produced
_____________________________________ as identification.
_________________________________
Notary Public
(Seal)
(Name of Notary Typed, Printed or Stamped)
Notary Public_______________________
State of ________________
My Commission Expires ____________
Return the completed form to:
Bureau of Food and Meat Inspection, Records Section
3125 Conner Blvd
Tallahassee, FL 32399-5520
fax - 850-245-5553
email – Food.Request@FreshFromFlorida.com
FDACS-14226 Rev. 10/15
Florida Department of Agriculture and Consumer Services
Division of Food Safety
Bureau of Food and Meat Inspection
Attention: Records Section
LIMITED ANNUAL SALES CERTIFICATION
3125 Conner Boulevard C-26
Tallahassee, FL 32399-1620
(850) 245-5520
ADAM H. PUTNAM
COMMISSIONER
Business Name
Food Entity #
Owner Name
_____
Owner Address
Owner City, State, Zip
Email ______________________________________________ Phone _____________________________
Our records indicate that you are currently operating under limited sales permit type:
If you had gross food sales of $15,000 or more during the last twelve months or anticipate having more than
$15,000 in gross sales during the next twelve months, you do not qualify for a limited sales category.
If you did not have gross food sales of $15,000 or more during the last twelve months, you must sign and have
this form notarized to verify your limited sales status. Failure to sign and have this form notarized prior to renewal
will result in the non-limited sales fee charged for this firm type.
I,
(owner of business), by my signature below and notarized statement
affirm that my food business has gross food sales less than $15,000 in the preceding 12 months, and
furthermore, I do not anticipate gross food sales of $15,000 or more during the next 12 months.
Anyone making a false statement with the intent of misleading an agent of the Department of Agriculture
and Consumer Services shall be guilty of a misdemeanor in the second degree.
Print/Type Name
Phone
_
_
_
_
Signature of Owner or Principal
Date
The foregoing instrument was acknowledged before me, the undersigned authority, by
_________________________, to me well known or who produced
_____________________________________ as identification.
_________________________________
Notary Public
(Seal)
(Name of Notary Typed, Printed or Stamped)
Notary Public_______________________
State of ________________
My Commission Expires ____________
Return the completed form to:
Bureau of Food and Meat Inspection, Records Section
3125 Conner Blvd
Tallahassee, FL 32399-5520
fax - 850-245-5553
email – Food.Request@FreshFromFlorida.com
FDACS-14226 Rev. 10/15
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