"Application for a Permit to Operate in Iowa as a Usda, Animal Care Licensed Facility" - Iowa

Application for a Permit to Operate in Iowa as a Usda, Animal Care Licensed Facility is a legal document that was released by the Iowa Department of Agriculture and Land Stewardship - a government authority operating within Iowa.

Form Details:

  • Released on August 1, 2011;
  • The latest edition currently provided by the Iowa Department of Agriculture and Land Stewardship;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Iowa Department of Agriculture and Land Stewardship.

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Download "Application for a Permit to Operate in Iowa as a Usda, Animal Care Licensed Facility" - Iowa

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IOWA DEPARTMENT OF AGRICULTURE & LAND STEWARDSHIP
Animal Welfare Bureau
Wallace State Office Building
th
(515) 281-8601
502 East 9
Street
(515) 281-6358
Des Moines, IA 50319
(515) 281-5305
APPLICATION FOR A PERMIT TO OPERATE IN IOWA AS A
USDA, Animal Care Licensed Facility
Permit Fees are Non-Refundable
All persons or businesses, which are licensed under the U.S.D.A. – A.P.H.I.S. (Federal) animal welfare law, must also obtain a permit
under the Iowa Animal Welfare Law, Chapter 162 Code of Iowa.
Federally licensed dealers or breeders, who are also operating pet shops, boarding kennels, commercial kennels (grooming or
training), or privately owned pounds, must be licensed with the State of Iowa to do business in those categories, as well as obtaining a
permit.
Permit Fee for a USDA, AC Licensed Facility
$175.00
___________________________________________________________
If you also plan on doing business as a pet shop, boarding kennel, pound or a commercial kennel, you will need to complete an
“Application to Operate in Iowa as a Licensed Animal Welfare Facility.”
_______________________________________________________________________________________
The applicant shall make request for a permit and complete the separate form if licensing in each of the categories (where applicable)
in which he is doing business. The fee submitted should be the total of the individual fees of business categories for which this
application is being made.
Name of Business:
Phone:
USDA, AC Certificate Number (REQUIRED):_____________________________________________________________________
Owner of Business:
E-Mail Address:
Street:
City:
Zip:
County:
Township:
Name(s) and Address (es) of branch operation:
Have you ever been convicted of animal abuse or neglect? Yes ____ No _____
Have you ever had a license revoked by the federal, state or local government to breed, care for or sell animals? Yes __ No__
Taxpayer Identification Number (EIN or SSN) REQUIRED: __________________________________________________________
*This is the number assigned to you or your business by the IRS*
*THIS WILL REMAIN CONFIDENTIAL.*
License permit fees shall accompany the application. Make checks or money orders payable to IDALS (Iowa Department of
Agriculture & Land Stewardship).
Signature:
Mail to:
Iowa Department of Agriculture & Land Stewardship
Animal Welfare Bureau
Date:
Wallace State Office Bldg.
502 East 9th Street
Des Moines, IA 50319
August 2011
CODE 97
IOWA DEPARTMENT OF AGRICULTURE & LAND STEWARDSHIP
Animal Welfare Bureau
Wallace State Office Building
th
(515) 281-8601
502 East 9
Street
(515) 281-6358
Des Moines, IA 50319
(515) 281-5305
APPLICATION FOR A PERMIT TO OPERATE IN IOWA AS A
USDA, Animal Care Licensed Facility
Permit Fees are Non-Refundable
All persons or businesses, which are licensed under the U.S.D.A. – A.P.H.I.S. (Federal) animal welfare law, must also obtain a permit
under the Iowa Animal Welfare Law, Chapter 162 Code of Iowa.
Federally licensed dealers or breeders, who are also operating pet shops, boarding kennels, commercial kennels (grooming or
training), or privately owned pounds, must be licensed with the State of Iowa to do business in those categories, as well as obtaining a
permit.
Permit Fee for a USDA, AC Licensed Facility
$175.00
___________________________________________________________
If you also plan on doing business as a pet shop, boarding kennel, pound or a commercial kennel, you will need to complete an
“Application to Operate in Iowa as a Licensed Animal Welfare Facility.”
_______________________________________________________________________________________
The applicant shall make request for a permit and complete the separate form if licensing in each of the categories (where applicable)
in which he is doing business. The fee submitted should be the total of the individual fees of business categories for which this
application is being made.
Name of Business:
Phone:
USDA, AC Certificate Number (REQUIRED):_____________________________________________________________________
Owner of Business:
E-Mail Address:
Street:
City:
Zip:
County:
Township:
Name(s) and Address (es) of branch operation:
Have you ever been convicted of animal abuse or neglect? Yes ____ No _____
Have you ever had a license revoked by the federal, state or local government to breed, care for or sell animals? Yes __ No__
Taxpayer Identification Number (EIN or SSN) REQUIRED: __________________________________________________________
*This is the number assigned to you or your business by the IRS*
*THIS WILL REMAIN CONFIDENTIAL.*
License permit fees shall accompany the application. Make checks or money orders payable to IDALS (Iowa Department of
Agriculture & Land Stewardship).
Signature:
Mail to:
Iowa Department of Agriculture & Land Stewardship
Animal Welfare Bureau
Date:
Wallace State Office Bldg.
502 East 9th Street
Des Moines, IA 50319
August 2011
CODE 97