"Egg Dealer License Application Form" - Colorado

Egg Dealer License Application Form is a legal document that was released by the Colorado Department of Agriculture - a government authority operating within Colorado.

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Download "Egg Dealer License Application Form" - Colorado

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ICS Egg Program
st
2331 W 31
Ave
Denver, CO 80211
303-477-0093
www.colorado.gov/ag
Egg Dealer License Application
January 1 – December 31 __________ (Year)
(Title 35, Article 21, C.R.S.)
st
Due December 31
if renewing.
Make check payable to Colorado Dept. of Agriculture and mail the completed form
and payment to the address listed above.
Egg Dealer License Classifications with Fees
Egg Producers
The Class I license is only for egg producers who sell their flock’s eggs to stores, restaurants and other institutions.
Egg producers are exempt from licensing if they only sell fewer than 40 cases per week directly to the final household consumer of eggs.
Please note if you are exempt on this application and return to the address above.
nd
Class I
Producer/Dealer: Complete the questions on 2
page of this application - - - - - - - - - - - - - - - - - - - - - -$25.00
Egg Dealers
Only for stores, wholesalers, and flock sizes over 3,000 Hens.
Average number of cases of eggs (30 dozen per case) sold per week during the previous 12 months - -
Number of Cases
Mark the appropriate box for the Class that matches the number of cases of eggs sold per week:
Class II Dealer: New dealer OR sells up to and including .5 cases per week (15 dozen) - - - - - - - - - - - - - - - - - - $20.00
Class III Dealer: Sells over .5 cases up to and including 2 cases per week (over 15 to 60 dozen)- - - - - - - - - - - - - $40.00
Class IV Dealer: Sells over 2 cases up to and including 25 cases per week (over 60 to 750 dozen)- - - - - - - - - - - - $75.00
Class V Dealer: Sells over 25 case up to and including 100 cases per week (over 750 to 3,000 dozen)- - - - - - - - $100.00
Class VI Dealer: Sells over 100 cases up to and including 500 cases per week (over 3,000 to 15,000 dozen) - - - - $200.00
Class VII Dealer: Sells over 500 cases per week (over 15,000 dozen) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $300.00
Late Penalty Fee: If renewal application postmarked after December 31
st
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $ _____________
Equal to the License fee, up to a maximum of $50.00
Total Fee Enclosed $ _________
Business Name: ______________________________________________________________________________
Full Business Address: _________________________________________________________________________
Full Mailing Address (if different): ______________________________________________________________
Email Address (Required): ___________________________________________________________________
Contact Name: ________________________________________ Phone Number: _______________________
I certify that all the statements made in this application are true, correct, and complete to the best of my knowledge
and belief, and are made in good faith.
Signature/Title: ______________________________________________________ Date: _______________________
ICS Egg Program
st
2331 W 31
Ave
Denver, CO 80211
303-477-0093
www.colorado.gov/ag
Egg Dealer License Application
January 1 – December 31 __________ (Year)
(Title 35, Article 21, C.R.S.)
st
Due December 31
if renewing.
Make check payable to Colorado Dept. of Agriculture and mail the completed form
and payment to the address listed above.
Egg Dealer License Classifications with Fees
Egg Producers
The Class I license is only for egg producers who sell their flock’s eggs to stores, restaurants and other institutions.
Egg producers are exempt from licensing if they only sell fewer than 40 cases per week directly to the final household consumer of eggs.
Please note if you are exempt on this application and return to the address above.
nd
Class I
Producer/Dealer: Complete the questions on 2
page of this application - - - - - - - - - - - - - - - - - - - - - -$25.00
Egg Dealers
Only for stores, wholesalers, and flock sizes over 3,000 Hens.
Average number of cases of eggs (30 dozen per case) sold per week during the previous 12 months - -
Number of Cases
Mark the appropriate box for the Class that matches the number of cases of eggs sold per week:
Class II Dealer: New dealer OR sells up to and including .5 cases per week (15 dozen) - - - - - - - - - - - - - - - - - - $20.00
Class III Dealer: Sells over .5 cases up to and including 2 cases per week (over 15 to 60 dozen)- - - - - - - - - - - - - $40.00
Class IV Dealer: Sells over 2 cases up to and including 25 cases per week (over 60 to 750 dozen)- - - - - - - - - - - - $75.00
Class V Dealer: Sells over 25 case up to and including 100 cases per week (over 750 to 3,000 dozen)- - - - - - - - $100.00
Class VI Dealer: Sells over 100 cases up to and including 500 cases per week (over 3,000 to 15,000 dozen) - - - - $200.00
Class VII Dealer: Sells over 500 cases per week (over 15,000 dozen) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $300.00
Late Penalty Fee: If renewal application postmarked after December 31
st
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $ _____________
Equal to the License fee, up to a maximum of $50.00
Total Fee Enclosed $ _________
Business Name: ______________________________________________________________________________
Full Business Address: _________________________________________________________________________
Full Mailing Address (if different): ______________________________________________________________
Email Address (Required): ___________________________________________________________________
Contact Name: ________________________________________ Phone Number: _______________________
I certify that all the statements made in this application are true, correct, and complete to the best of my knowledge
and belief, and are made in good faith.
Signature/Title: ______________________________________________________ Date: _______________________
ICS Egg Program
st
2331 W 31
Ave
Denver, CO 80211
303-477-0093
www.colorado.gov/ag
Questions for Small-Flock Egg Producers Only:
1. Check all proposed markets:
Stores
Restaurants
Farmer’s Markets
Farm
Egg Distributor
CSA
2. Number of hens in the flock: __________________
3. Weekly egg production: ____________________
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