"Farm Products Small Volume Dealer License Application" - Colorado

Farm Products Small Volume Dealer License Application is a legal document that was released by the Colorado Department of Agriculture - a government authority operating within Colorado.

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Download "Farm Products Small Volume Dealer License Application" - Colorado

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Farm Products Program: (303) 477-0054
Farm Products Small Volume Dealer License Application
January 1 – December 31 __________ (Year)
Make check payable to:
Colorado Dept. of Agriculture
(4540) License: New ___ Renewal ___
$25.00
(4610) Penalty (after Dec. 31
st
) $25.00
$______
Colorado Dept. of Agriculture/ ICS
Mail payment and
application to:
2331 West 31
st
Avenue
Total amount enclosed
$______
Denver, CO 80211
All payments must be payable in U.S. dollars and checks must be drawn on a U.S. bank or the payment and this form will be returned.
1. Business name of applicant:
2. Principal business address:
Mailing address if different:
3. Phone number:
County:
4. Email address:
5.
(Check one) This business is operating as a(n):
__ Individual/Sole Proprietorship*
__ Partnership
__ Corporation
__ Other (Describe): ___________________________________________________________________________________________
*If you are operating as an individual/sole proprietorship, you must complete the “Citizenship/Immigration Status Verification Form”
6.
State kinds of farm products handled: ____________________________________________________________________________
7.
Are you engaged in the business of buying farm products from Colorado producers or dealers?
Yes:__ No:__
If Yes, state your annual dollar volume of purchases of farm products from Colorado producers or dealers:
$___________
8.
Do you solicit or negotiate the sale of farm products between the vendor and purchaser respectively?
Yes:__ No:__
9.
Do you receive on consignment or handle any farm product on a commission basis?
Yes:__ No:__
10. List person(s) authorized to receive and accept service of summons and legal notices of all kinds for the applicant in the state of
Colorado (name and complete address):
Name: _________________________________________ Address: ______________________________________________________
“Small volume dealer” has a place of business in Colorado and buys less than twenty thousand dollars’ worth of
farm products per year from producers and owners of farm products for processing or resale and does not purchase
two thousand five hundred dollars’ worth or more of farm products in a single transaction.
I understand that as a dealer I must comply with all requirements of the Farm Products Act (Title 35, Article 37,
Sections 101 et. Seq. C.R.S.). I understand that making false statements on this application is punishable by law.
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.
Legal Name of Applicant: ______________________________________________________________
Date: ________ Signature: _____________________________________________________________
Farm Products Program: (303) 477-0054
Farm Products Small Volume Dealer License Application
January 1 – December 31 __________ (Year)
Make check payable to:
Colorado Dept. of Agriculture
(4540) License: New ___ Renewal ___
$25.00
(4610) Penalty (after Dec. 31
st
) $25.00
$______
Colorado Dept. of Agriculture/ ICS
Mail payment and
application to:
2331 West 31
st
Avenue
Total amount enclosed
$______
Denver, CO 80211
All payments must be payable in U.S. dollars and checks must be drawn on a U.S. bank or the payment and this form will be returned.
1. Business name of applicant:
2. Principal business address:
Mailing address if different:
3. Phone number:
County:
4. Email address:
5.
(Check one) This business is operating as a(n):
__ Individual/Sole Proprietorship*
__ Partnership
__ Corporation
__ Other (Describe): ___________________________________________________________________________________________
*If you are operating as an individual/sole proprietorship, you must complete the “Citizenship/Immigration Status Verification Form”
6.
State kinds of farm products handled: ____________________________________________________________________________
7.
Are you engaged in the business of buying farm products from Colorado producers or dealers?
Yes:__ No:__
If Yes, state your annual dollar volume of purchases of farm products from Colorado producers or dealers:
$___________
8.
Do you solicit or negotiate the sale of farm products between the vendor and purchaser respectively?
Yes:__ No:__
9.
Do you receive on consignment or handle any farm product on a commission basis?
Yes:__ No:__
10. List person(s) authorized to receive and accept service of summons and legal notices of all kinds for the applicant in the state of
Colorado (name and complete address):
Name: _________________________________________ Address: ______________________________________________________
“Small volume dealer” has a place of business in Colorado and buys less than twenty thousand dollars’ worth of
farm products per year from producers and owners of farm products for processing or resale and does not purchase
two thousand five hundred dollars’ worth or more of farm products in a single transaction.
I understand that as a dealer I must comply with all requirements of the Farm Products Act (Title 35, Article 37,
Sections 101 et. Seq. C.R.S.). I understand that making false statements on this application is punishable by law.
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.
Legal Name of Applicant: ______________________________________________________________
Date: ________ Signature: _____________________________________________________________