Form DL-2 Application for License - Dealers in Farm Produce - Hawaii

Form DL-2 or the "Application For License - Dealers In Farm Produce" is a form issued by the Hawaii Department of Agriculture.

Download a PDF version of the Form DL-2 down below or find it on the Hawaii Department of Agriculture Forms website.

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DL-2
FOR OFFICE USE ONLY
04/10
State of Hawaii
New ______ Update ________
DEPARTMENT OF AGRICULTURE
Commodities Branch
Receipt No ________________
Quality Assurance Division
Receipt Date ______________
1851 Auiki Street
Amount Paid ______________
Honolulu, Hawaii 96819-3100
Penalty Amount ____________
APPLICATION FOR LICENSE - DEALERS IN FARM PRODUCE
Date Lic Issued ____________
Please read attached sheet before completing application.
SECTION A. TO BE COMPLETED BY ALL APPLICANTS
1. NAME OF BUSINESS: (Please print)
3. CLASS OF BUSINESS: (See attached sheet for definitions and check
all applicable classes. )
COMMISSION MERCHANT
DEALER
PROCESSOR
BROKER
AGENT
RETAIL MERCHANT
4a. BUS PHONE:
2. PLACE OF BUSINESS: (No. and Street, City, State, ZIP)
4b. BUS FAX:
4c. EMAIL:
5. MAILING ADDRESS: (If same as block 2, write “Same”.)
This is a corporate or executive office (see instructions).
6. HAWAII GROWN FARM PRODUCTS OBTAINED OR PURCHASED DIRECTLY FROM PRODUCER: (Check all applicable products.)
FLOWERS
COFFEE
EGGS
POULTRY
PLANTS
OTHERS
FRESH FRUITS OR VEGETABLES
LIVESTOCK OR LIVESTOCK PRODUCTS
7. DATE FIRST HANDLED ABOVE FARM PRODUCT(S) AND BECAME
8. DATE BUSINESS STARTED:
SUBJECT TO LICENSING: (Month/Day/Year)
9. BUSINESS IS: (CHECK APPLICABLE SQUARE AND COMPLETE BLOCKS 10 TO 13 AS REQUIRED.)
SOLE OWNER
PARTNERSHIP
CORPORATION OR ASSOCIATION
Print NAME and home ADDRESS of Owner in
Indicate above, type of partnership
Print NAME, home ADDRESS and TITLE of all
blocks 10 and 11.
(GENERAL, LIMITED or SPECIAL)
directors or officers and holders of more than ten
Print NAME and home ADDRESS of all
percent of outstanding stock and the PERCENT-
partners in blocks 10 and 11.
AGE OF STOCK held by each in blocks 10 to 13.
10.
11.
12.
13.
PERCENT
NAME
HOME ADDRESS
TITLE
STOCK
(Note: Attach separate sheet if additional space is needed.)
PLEASE SEE REVERSE SIDE
DL-2
FOR OFFICE USE ONLY
04/10
State of Hawaii
New ______ Update ________
DEPARTMENT OF AGRICULTURE
Commodities Branch
Receipt No ________________
Quality Assurance Division
Receipt Date ______________
1851 Auiki Street
Amount Paid ______________
Honolulu, Hawaii 96819-3100
Penalty Amount ____________
APPLICATION FOR LICENSE - DEALERS IN FARM PRODUCE
Date Lic Issued ____________
Please read attached sheet before completing application.
SECTION A. TO BE COMPLETED BY ALL APPLICANTS
1. NAME OF BUSINESS: (Please print)
3. CLASS OF BUSINESS: (See attached sheet for definitions and check
all applicable classes. )
COMMISSION MERCHANT
DEALER
PROCESSOR
BROKER
AGENT
RETAIL MERCHANT
4a. BUS PHONE:
2. PLACE OF BUSINESS: (No. and Street, City, State, ZIP)
4b. BUS FAX:
4c. EMAIL:
5. MAILING ADDRESS: (If same as block 2, write “Same”.)
This is a corporate or executive office (see instructions).
6. HAWAII GROWN FARM PRODUCTS OBTAINED OR PURCHASED DIRECTLY FROM PRODUCER: (Check all applicable products.)
FLOWERS
COFFEE
EGGS
POULTRY
PLANTS
OTHERS
FRESH FRUITS OR VEGETABLES
LIVESTOCK OR LIVESTOCK PRODUCTS
7. DATE FIRST HANDLED ABOVE FARM PRODUCT(S) AND BECAME
8. DATE BUSINESS STARTED:
SUBJECT TO LICENSING: (Month/Day/Year)
9. BUSINESS IS: (CHECK APPLICABLE SQUARE AND COMPLETE BLOCKS 10 TO 13 AS REQUIRED.)
SOLE OWNER
PARTNERSHIP
CORPORATION OR ASSOCIATION
Print NAME and home ADDRESS of Owner in
Indicate above, type of partnership
Print NAME, home ADDRESS and TITLE of all
blocks 10 and 11.
(GENERAL, LIMITED or SPECIAL)
directors or officers and holders of more than ten
Print NAME and home ADDRESS of all
percent of outstanding stock and the PERCENT-
partners in blocks 10 and 11.
AGE OF STOCK held by each in blocks 10 to 13.
10.
11.
12.
13.
PERCENT
NAME
HOME ADDRESS
TITLE
STOCK
(Note: Attach separate sheet if additional space is needed.)
PLEASE SEE REVERSE SIDE
SECTION B. TO BE COMPLETED BY APPLICANT WITH BRANCH STORE(S) See instruction sheet
14. NAME, ADDRESS AND PHONE NUMBER OF EACH BRANCH STORE. A separate application must be completed for each Branch Store established
subsequent to the filing of this application.
DO NOT WRITE IN LIC. NO. BLOCK, for office use only.
MAIN OR PARENT STORE
5.
PHONE:
PHONE:
LIC. NO.
LIC. NO.
1. BRANCH STORES
6.
LIC. NO.
PHONE:
LIC. NO.
PHONE:
2.
7.
PHONE:
PHONE:
LIC. NO.
LIC. NO.
3.
8.
PHONE:
LIC. NO.
PHONE:
LIC. NO.
4.
9.
LIC. NO.
PHONE:
PHONE:
LIC. NO.
(Note: Attach separate sheet if additional space is needed)
SECTION C. TO BE COMPLETED BY ALL APPLICANTS
15. BANKING REFERENCE: Name and Branch of Bank
16. NAME OF PERSON AUTHORIZED TO RECEIVE AND ACCEPT SUMMONS AND LEGAL NOTICES.
AGENT OR COMMISSION MERCHANT APPLICANTS SEE ATTACHED INSTRUCTIONS FOR ADDITIONAL REQUIREMENTS.
COMMISSION MERCHANT or BROKERS ATTACH SURETY BOND for $3,000.00.
LICENSE FEE (See attached sheet for instructions.)
Commission Merchant, Agent,
Broker, Dealer or Processor (each)........$40.00
Signature of Applicant
Retail Merchant.......................................$10.00
Title
Branch Store.............................................$5.00
Penalty: See instruction sheet
Date
Make check payable to: HAWAII DEPT. OF AGRICULTURE
and mail to :
COMMODITIES BRANCH
1851 Auiki Street
Honolulu, HI 96819-3100
REMINDER: DID YOU SIGN THIS APPLICATION?
DL-2a
04/10
INFORMATION AND INSTRUCTIONS
APPLICATION FOR LICENSE DEALERS IN FARM PRODUCE
GENERAL LICENSE REQUIREMENT
A license from the HAWAII DEPARTMENT OF AGRICULTURE is required if you handle or sell any HAWAII
GROWN Agricultural Product, such as...
PLANTS
FLOWERS
ISLAND EGGS or POULTRY
FRESH FRUITS or VEGETABLES
ISLAND LIVESTOCK or LIVESTOCK PRODUCTS
and the product was OBTAINED OR PURCHASED BY YOU DIRECTLY FROM A HAWAII FARMER OR
GROWER.
CLASS OF BUSINESS - DEFINITIONS (Item 3 of application)
COMMISSION MERCHANT means any person who receives on consignment or solicits from the producer thereof
any farm product for sale on commission on behalf of such producer, or who accepts any farm product in trust from
the producer thereof for the purpose of resale, or who sells or offers for sale on commission any farm product, or who
in any way handles for the account of or as an agent of the producer thereof any farm product.
DEALER means any person, other than a commission merchant, who solicits or obtains possession or control of any
farm product at a specified unit price from a producer thereof for resale in its natural state to other than the consumer
thereof.
BROKER means any person, other than a commission merchant or dealer, who negotiates the purchase or sale of
any farm product. A broker may not obtain possession of any farm product involved.
AGENT means any person who, on behalf of any commission merchant, dealer, broker, processor or retail merchant
receives, contracts for or solicits any farm products from a producer thereof, or who negotiates the consignment or
purchase of any farm product on behalf of any commission merchant, dealer, broker, processor or retail merchant.
PROCESSOR means any person who contracts for or obtains possession of any farm product from the producer
thereof for resale in a processed form, but shall not include hotels, restaurants, or other persons furnishing meals, nor
shall it include any person who processes any farm produce solely for sale directly to a consumer.
RETAIL MERCHANT means any person who solicits or obtains from a producer thereof title, possessions or control
of any farm product at a specified unit price for sale at retail to a consumer. For the purpose of this definition, sales
to the United States Armed Forces, restaurants, hotels, hospitals or institutions are not retail sales.
BRANCH STORE LICENSE (Section B, Item 14 of application)
BRANCH STORE means any additional store owned and operated by a person subject to licensing which conducts
the same class of business.
A license is required for each Branch Store and may be obtained by the main store or parent company.
A separate license is not required for the executive or corporate office, if listed in Item 1 of the application. The main
store or parent store shall be the first store listed in Item 14 and shall pay the proper license fee required for
its class of business. All other stores listed in Item 14 shall be classified as branch stores providing they are under
the same corporate charter, partnership or ownership as the main store.
(over)
LICENSE FEES
If your business falls under only one class of business, pay only that specified fee. If it falls under more than one
class of business, the general rule is that no additional license fee is required if the license fee for a class of business
having a higher fee is paid. Following are examples:
a. A COMMISSION MERCHANT shall pay a $40 license fee.
b. A DEALER, PROCESSOR, BROKER or AGENT shall pay $40 for each classification. They may also operate as
a Retail Merchant with no additional fee.
c. A RETAIL MERCHANT shall pay a $10 license fee and can operate only as a retail merchant.
d. Each BRANCH STORE must pay a $5 fee and can conduct the classes of business for which the main store is
licensed.
PENALTY: If the date in Item 7 of the application is more than thirty days from the date of filing the application, a
penalty will be in effect. Please contact Commodities Branch personnel prior to calculating your license fee.
ADDITIONAL REQUIREMENTS
COMMISSION MERCHANT OR BROKER CLASSIFICATION
Form DL-3 must be completed and submitted with the application. Commission Merchants and Brokers are also
required to execute and deliver to the Director, a surety bond in the sum of $3,000.00. A printed bond form DL-10 is
available on request.
AGENT CLASSIFICATION
Form DL-3 must be completed and submitted with the application. An agent’s license expires with that of his principal.
SIGNATURE
DON’T FORGET TO SIGN AND DATE YOUR APPLICATION, Mail with your payment to:
COMMODITIES BRANCH
1851 Auiki Street
Honolulu, HI 96819-3100
IF YOU HAVE ANY QUESTIONS, PLEASE TELEPHONE THE COMMODITIES BRANCH OFFICE:
HONOLULU
KONA
MAUI
KAUAI
323-7589
873-3554
274-3073
832-0709

Download Form DL-2 Application for License - Dealers in Farm Produce - Hawaii

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