Form CF.ACC.11 "Honey Bee Submission Form" - Alabama

What Is Form CF.ACC.11?

This is a legal form that was released by the Alabama Department of Agriculture and Industries - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2011;
  • The latest edition provided by the Alabama Department of Agriculture and Industries;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CF.ACC.11 by clicking the link below or browse more documents and templates provided by the Alabama Department of Agriculture and Industries.

ADVERTISEMENT
ADVERTISEMENT

Download Form CF.ACC.11 "Honey Bee Submission Form" - Alabama

1492 times
Rate (4.8 / 5) 90 votes
Accession #
Thompson-Bishop-Sparks State Diagnostic Laboratory
890 Simms Rd P.O. Box 2209 Auburn, AL 36831-2209
Date
(334) 844-4987
Fax- (334) 844-7224
Case coordinator
Honey Bee Submission Form
Paid
Charge
N/C
Submitted samples become the property of the laboratory
FedEx
UPS
USPS
Other
Submitter/Inspector
Apiary Owner
License #
Account #
County
Address
Address
Phone
Phone
Fax
Fax
Email
Previous case #
Submitted by:  Inspector  Owner  Other
Bill to:  Submitter  Owner  Other
Print name
Signature
Date
Species
Sample
Test Request
 Honey Bees
 Africanized Honey Bee
# Fresh
# Fixed
 Other (identify)
 Foulbrood
Honey Bees
 Parasites/Mites
List Apiary and Sample ID
 Fungal diseases
below.
Submission Purpose
 Viral diseases
 Diagnostic
 Referral
 Regulatory
 Other
_______________________
Case No.
Apiary Site
Sample No.
History/ problem description
Total # Hives ___ # Affected ___# Lost____
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
Duration/ progression
Treatment
____________________________________
Continued on back of form
____________________________________
____________________________________
Some testing may be subcontracted out to qualified laboratories. You will be contacted for permission if this will incur further charges
CF.ACC.11.1AuburnBeeSubForm KLF February 2011 Page 1 of 2
Accession #
Thompson-Bishop-Sparks State Diagnostic Laboratory
890 Simms Rd P.O. Box 2209 Auburn, AL 36831-2209
Date
(334) 844-4987
Fax- (334) 844-7224
Case coordinator
Honey Bee Submission Form
Paid
Charge
N/C
Submitted samples become the property of the laboratory
FedEx
UPS
USPS
Other
Submitter/Inspector
Apiary Owner
License #
Account #
County
Address
Address
Phone
Phone
Fax
Fax
Email
Previous case #
Submitted by:  Inspector  Owner  Other
Bill to:  Submitter  Owner  Other
Print name
Signature
Date
Species
Sample
Test Request
 Honey Bees
 Africanized Honey Bee
# Fresh
# Fixed
 Other (identify)
 Foulbrood
Honey Bees
 Parasites/Mites
List Apiary and Sample ID
 Fungal diseases
below.
Submission Purpose
 Viral diseases
 Diagnostic
 Referral
 Regulatory
 Other
_______________________
Case No.
Apiary Site
Sample No.
History/ problem description
Total # Hives ___ # Affected ___# Lost____
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
Duration/ progression
Treatment
____________________________________
Continued on back of form
____________________________________
____________________________________
Some testing may be subcontracted out to qualified laboratories. You will be contacted for permission if this will incur further charges
CF.ACC.11.1AuburnBeeSubForm KLF February 2011 Page 1 of 2
Sample continuation
Accession #
Case No.
Apiary Site
Sample No.
CF.ACC.11.1AuburnBeeSubForm KLF February 2011 Page 2 of 2
Page of 2