Form SPS14-05 "Unlicensed Structural Pest Control Operator Notification Form" - Georgia (United States)

What Is Form SPS14-05?

This is a legal form that was released by the Georgia Department of Agriculture - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Georgia Department of Agriculture;
  • 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 printable version of Form SPS14-05 by clicking the link below or browse more documents and templates provided by the Georgia Department of Agriculture.

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Download Form SPS14-05 "Unlicensed Structural Pest Control Operator Notification Form" - Georgia (United States)

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Structural Pest Section
19 Martin Luther King, Jr. Dr.
Atlanta, Georgia 30334-4201
Phone: (404) 656-3641
Unlicensed Structural Pest Control Operator Notification Form
I would like to submit the following observations (which might include evidence such as photos, contracts, receipts, etc.) of what
would appear to be unlicensed pest control operations to the Department. Send to
pest@agr.georgia.gov
or mail to address above.
Observations:
Date:___________ Time:_____________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Location where activity observed: (if any)
County:_____________________
____________________________________________________________________________________
Street Address
_____________________________________________________________________________________
City
State
Zip Code
Vehicle involved (if any)
TAG:_____________ (
)
if not GA, indicate STATE_____
Indicate if vehicle displayed any markings/company name (if any)
______________________________________________________________________________
Indicate location where vehicle is parked/garaged (if known)
______________________________________________________________________________
Make:_____________ Model:_______________ Color:_______________ Year:_____________
SUSPECTED CUSTOMERS (if any)
____________________________________
_________________________________
Name of Individual(s)
Contact telephone number
______________________________________________________________________________
Street Address
City
State
Zip Code
YOUR CONTACT INFORMATION
____________________________________
________________________________
Name
Contact telephone numb er
SPS 14-05
Structural Pest Section
19 Martin Luther King, Jr. Dr.
Atlanta, Georgia 30334-4201
Phone: (404) 656-3641
Unlicensed Structural Pest Control Operator Notification Form
I would like to submit the following observations (which might include evidence such as photos, contracts, receipts, etc.) of what
would appear to be unlicensed pest control operations to the Department. Send to
pest@agr.georgia.gov
or mail to address above.
Observations:
Date:___________ Time:_____________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Location where activity observed: (if any)
County:_____________________
____________________________________________________________________________________
Street Address
_____________________________________________________________________________________
City
State
Zip Code
Vehicle involved (if any)
TAG:_____________ (
)
if not GA, indicate STATE_____
Indicate if vehicle displayed any markings/company name (if any)
______________________________________________________________________________
Indicate location where vehicle is parked/garaged (if known)
______________________________________________________________________________
Make:_____________ Model:_______________ Color:_______________ Year:_____________
SUSPECTED CUSTOMERS (if any)
____________________________________
_________________________________
Name of Individual(s)
Contact telephone number
______________________________________________________________________________
Street Address
City
State
Zip Code
YOUR CONTACT INFORMATION
____________________________________
________________________________
Name
Contact telephone numb er
SPS 14-05