Form AG-00960 "Application for Grain Buyer License" - Minnesota

What Is Form AG-00960?

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

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the Minnesota 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 AG-00960 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

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Download Form AG-00960 "Application for Grain Buyer License" - Minnesota

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Plant Protection Division, Ph. 651-201-6011
Entity ID:
Minn. Stat. Ch. 223
20___ APPLICATION FOR GRAIN BUYER LICENSE
The data on this form will be used to process your application. You must provide your Minnesota Tax ID number. If you do not have one, you must provide your social security number
(MS Sec 270C.72). We are required by law to collect this information and we cannot grant your license without it. No one will have access to your social security number except those
permitted access by law, your written consent, court order, or those department employees whose job duties require access. If you are unsure if you need a Minnesota Tax ID,
contact the Minnesota Department of Revenue at www.taxes.state.mn.us.
Legal Name
MN Tax ID or if none, Social Security
DBA (if different)
Mailing Address (if different):
Physical Street Address (No PO Box)
City
State
Zip Code
City
State
Zip Code
Company Telephone
Workers' Compensation:
Do you have any paid or otherwise compensated employees in Minnesota?
Yes
No If yes, complete the following information:
Insurance Company Name:
Effective Date:
Expiration Date:
Policy #:
You must provide acceptable evidence of compliance with the Workers' Compensation Insurance Law (MS Sec 176.182). If you are self-insured, attach a copy of the exemption
order from the Commissioner of Commerce authorizing self-insurance. For questions, contact the Minnesota Department of Labor and Industry at www.doli.state.mn.us.
Do you purchase grain on contract (deferred payment, priced later, etc)?
Yes
No
When is your Fiscal Year End:_____/_____/_____
(Attach additional sheets if necessary)
Licensed Locations:
License
Buyer Fee
Number
Address
County
City/Zip
600506(3100)
(office use only)
$
$
$
Buyer Fee (Calculate as per below):
Bond Requirements:
Gross annual Grain Purchases (GAGP) First Location Additional Location
Grain Buyer applicants must secure a Grain Bond in the
Less than $100,000
$140.00
$110.00
amount of $50,000 for the first year. Only one Grain
$100,000 to $750,000
$275.00
$110.00
Bond is required to cover all licensed locations.
$750,000 to $1,500,000
$415.00
$220.00
$1,500,000 to $3,000,000
$550.00
$220.00
$3,000,000 or More
$700.00
$220.00
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Licenses are not transferable and fees are not refundable.
I hereby certify that the information contained in and submitted with this form is true and correct.
For Office Use Only
Signature: ________________________________________
Date: ____________________
Name (Please print): ________________________________
Title: ____________________
Contact Telephone: ________________________ Fax Number: _______________________
E-mail Address: ______________________________________________________________
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651/201-6000. TTY users can
call the Minnesota Relay Service at 711 or 1-800-627-3529. The MDA is an equal opportunity employer and provider.
AG-00960 (07/13)
Page 1 of 1
Plant Protection Division, Ph. 651-201-6011
Entity ID:
Minn. Stat. Ch. 223
20___ APPLICATION FOR GRAIN BUYER LICENSE
The data on this form will be used to process your application. You must provide your Minnesota Tax ID number. If you do not have one, you must provide your social security number
(MS Sec 270C.72). We are required by law to collect this information and we cannot grant your license without it. No one will have access to your social security number except those
permitted access by law, your written consent, court order, or those department employees whose job duties require access. If you are unsure if you need a Minnesota Tax ID,
contact the Minnesota Department of Revenue at www.taxes.state.mn.us.
Legal Name
MN Tax ID or if none, Social Security
DBA (if different)
Mailing Address (if different):
Physical Street Address (No PO Box)
City
State
Zip Code
City
State
Zip Code
Company Telephone
Workers' Compensation:
Do you have any paid or otherwise compensated employees in Minnesota?
Yes
No If yes, complete the following information:
Insurance Company Name:
Effective Date:
Expiration Date:
Policy #:
You must provide acceptable evidence of compliance with the Workers' Compensation Insurance Law (MS Sec 176.182). If you are self-insured, attach a copy of the exemption
order from the Commissioner of Commerce authorizing self-insurance. For questions, contact the Minnesota Department of Labor and Industry at www.doli.state.mn.us.
Do you purchase grain on contract (deferred payment, priced later, etc)?
Yes
No
When is your Fiscal Year End:_____/_____/_____
(Attach additional sheets if necessary)
Licensed Locations:
License
Buyer Fee
Number
Address
County
City/Zip
600506(3100)
(office use only)
$
$
$
Buyer Fee (Calculate as per below):
Bond Requirements:
Gross annual Grain Purchases (GAGP) First Location Additional Location
Grain Buyer applicants must secure a Grain Bond in the
Less than $100,000
$140.00
$110.00
amount of $50,000 for the first year. Only one Grain
$100,000 to $750,000
$275.00
$110.00
Bond is required to cover all licensed locations.
$750,000 to $1,500,000
$415.00
$220.00
$1,500,000 to $3,000,000
$550.00
$220.00
$3,000,000 or More
$700.00
$220.00
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Licenses are not transferable and fees are not refundable.
I hereby certify that the information contained in and submitted with this form is true and correct.
For Office Use Only
Signature: ________________________________________
Date: ____________________
Name (Please print): ________________________________
Title: ____________________
Contact Telephone: ________________________ Fax Number: _______________________
E-mail Address: ______________________________________________________________
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651/201-6000. TTY users can
call the Minnesota Relay Service at 711 or 1-800-627-3529. The MDA is an equal opportunity employer and provider.
AG-00960 (07/13)
Page 1 of 1