Form AES-07-80 "Application for Reciprocal Pesticide Applicators License" - Louisiana

This version of the form is not currently in use and is provided for reference only.
Download this version of Form AES-07-80 for the current year.

What Is Form AES-07-80?

This is a legal form that was released by the Louisiana Department of Agriculture & Forestry - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2017;
  • The latest edition provided by the Louisiana Department of Agriculture & Forestry;
  • 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 AES-07-80 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Agriculture & Forestry.

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Download Form AES-07-80 "Application for Reciprocal Pesticide Applicators License" - Louisiana

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L
D
A
F
OUISIANA
EPARTMENT OF
GRICULTURE &
ORESTRY
M
S
, C
DVM
IKE
TRAIN
OMMISSIONER
Agricultural & Environmental Sciences, 5825 Florida Blvd., Suite 1003, Baton Rouge, LA 70806, (225) 925-3763, FAX (225) 925-3760
APPLICATION FOR RECIPROCAL PESTICIDE APPLICATORS LICENSE
NAME:
E-MAIL:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
CELL PHONE: (
)
WORK PHONE: (
)
PLACE OF EMPLOYMENT:
EMPLOYMENT ADDRESS:
STATE LICENSED IN:
LICENSE #:
LICENSE EXPIRATION:
COMMERCIAL PESTICIDE APPLICATOR CATEGORIES
1
Agricultural Pest Control
7c2 Non-Fee Vertebrate Control
2a
General Forestry Pest Control
7c3 Non-Fee Stored Grain
2b
Forestry Tree Seed Orchards & Nurseries
7d
Non-Fee School Employee
2c
Wood Processing
8a
Mosquito Control Applicator
3
Ornamental & Turf Pest Control
8b
Rodent Control
4
Seed Treatment
8c
Community Public Health
5a
Aquatic Pest Control
8d
Mosquito Control Program Director
5b
Antifouling Paints
8e
Antimicrobial Pest Control
6
Right of Way & Industrial Pest Control
8f
Sewer Root Control
7b
Non-Fee Institutional Pest Control
10
Demonstration & Research
7c1 Non-Fee General Pest Control
11
Aerial Pesticide Applicator
RUP Salesperson
Resident Agent Designation
Name of person who is a resident of Louisiana and who will receive papers as your resident agent should enforcement actions be taken
upon you. In lieu of a personally known representative, the applicant may designate, in writing, the Louisiana Secretary of State as their
resident agent.
Louisiana Secretary of State is designated as my resident agent.
OR
Name of selected resident agent:
Title:
PHONE: (
)
Business Name:
Address:
I hereby certify that the above information is, to the best of my knowledge, correct and reliable.
Signature
Date
Submit the following items:
Completed Form
Please Return this Form & Remittance to:
Photocopy of your Pesticide Applicator’s License in the state you tested.
Louisiana Department of Agriculture & Forestry
Photocopy of a valid government issued identification card.
5825 Florida Blvd., Suite 1003
Payment - $20.00 annual Certification Card fee
Baton Rouge LA 70806
Check or money order payable to Louisiana Department of
Agriculture & Forestry
OFFICE USE
In accordance with Article 7, Section 9 of the Constitution for the State of Louisiana, the Department of
Transmittal #
Agriculture & Forestry is required to immediately deposit all funds collected into the State Treasury. Deposit
Check #
of your check in the State Treasury does not indicate you qualify for the reciprocal license. If for any reason
you do not qualify for the reciprocal license, you will receive a refund.
Date
AES-07-80 (r.5/17)
CERTIFICATION
0800 1605 05
.00
Amt. $
L
D
A
F
OUISIANA
EPARTMENT OF
GRICULTURE &
ORESTRY
M
S
, C
DVM
IKE
TRAIN
OMMISSIONER
Agricultural & Environmental Sciences, 5825 Florida Blvd., Suite 1003, Baton Rouge, LA 70806, (225) 925-3763, FAX (225) 925-3760
APPLICATION FOR RECIPROCAL PESTICIDE APPLICATORS LICENSE
NAME:
E-MAIL:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
CELL PHONE: (
)
WORK PHONE: (
)
PLACE OF EMPLOYMENT:
EMPLOYMENT ADDRESS:
STATE LICENSED IN:
LICENSE #:
LICENSE EXPIRATION:
COMMERCIAL PESTICIDE APPLICATOR CATEGORIES
1
Agricultural Pest Control
7c2 Non-Fee Vertebrate Control
2a
General Forestry Pest Control
7c3 Non-Fee Stored Grain
2b
Forestry Tree Seed Orchards & Nurseries
7d
Non-Fee School Employee
2c
Wood Processing
8a
Mosquito Control Applicator
3
Ornamental & Turf Pest Control
8b
Rodent Control
4
Seed Treatment
8c
Community Public Health
5a
Aquatic Pest Control
8d
Mosquito Control Program Director
5b
Antifouling Paints
8e
Antimicrobial Pest Control
6
Right of Way & Industrial Pest Control
8f
Sewer Root Control
7b
Non-Fee Institutional Pest Control
10
Demonstration & Research
7c1 Non-Fee General Pest Control
11
Aerial Pesticide Applicator
RUP Salesperson
Resident Agent Designation
Name of person who is a resident of Louisiana and who will receive papers as your resident agent should enforcement actions be taken
upon you. In lieu of a personally known representative, the applicant may designate, in writing, the Louisiana Secretary of State as their
resident agent.
Louisiana Secretary of State is designated as my resident agent.
OR
Name of selected resident agent:
Title:
PHONE: (
)
Business Name:
Address:
I hereby certify that the above information is, to the best of my knowledge, correct and reliable.
Signature
Date
Submit the following items:
Completed Form
Please Return this Form & Remittance to:
Photocopy of your Pesticide Applicator’s License in the state you tested.
Louisiana Department of Agriculture & Forestry
Photocopy of a valid government issued identification card.
5825 Florida Blvd., Suite 1003
Payment - $20.00 annual Certification Card fee
Baton Rouge LA 70806
Check or money order payable to Louisiana Department of
Agriculture & Forestry
OFFICE USE
In accordance with Article 7, Section 9 of the Constitution for the State of Louisiana, the Department of
Transmittal #
Agriculture & Forestry is required to immediately deposit all funds collected into the State Treasury. Deposit
Check #
of your check in the State Treasury does not indicate you qualify for the reciprocal license. If for any reason
you do not qualify for the reciprocal license, you will receive a refund.
Date
AES-07-80 (r.5/17)
CERTIFICATION
0800 1605 05
.00
Amt. $