Form AG-00890 "Application for Soil/Plant Amendment Product Registration" - Minnesota

What Is Form AG-00890?

This is a legal form that was released by the Minnesota Agriculture Department - 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 November 1, 2014;
  • The latest edition provided by the Minnesota Agriculture Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form AG-00890 by clicking the link below or browse more documents and templates provided by the Minnesota Agriculture Department.

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Download Form AG-00890 "Application for Soil/Plant Amendment Product Registration" - Minnesota

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Pesticide & Fertilizer Management Division, Ph. 651-201-6379 Fax 651-201-6112
Minn. Stat. Sec. 18C.411
20______APPLICATION FOR SOIL/PLANT AMENDMENT PRODUCT REGISTRATION
License Period of January 1 to December 31
Do you currently hold a Minnesota Soil/Plant Amendment Product Registration Number:
No
Yes
If yes, MN Lic. No:__________________
GUARANTOR AS LABELED IN MINNESOTA (Complete below)
REGISTRANT (Complete if different from Guarantor)
Legal Name:
Legal Name:
DBA (if different):
DBA (if different):
Street Address:
Mailing Address:
City:
State:
City:
State:
Zip Code:
Zip Code:
Company Telephone:
Company Telephone:
COMPLETE BRAND NAME OF SOIL AND PLANT AMENDMENT
ITEM
Product registration WILL NOT be granted until product label/label fascimile and material used in promoting the sale of each product is
NO.
submitted with application.
1
2
3
4
5
6
7
8
9
10
Application Fees:
$__________________
Number of New Products ____________ X $200.00 each
Total Amount Due
600296(3100)
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Registrations are not transferable and fees are not refundable.
For Office Use Only
I hereby certify that the information contained in and submitted with this form is true and correct.
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
AG-00890 (11/14)
call the Minnesota Relay Service at 711 or 1-800-627-3529. The MDA is an equal opportunity employer and provider.
Pesticide & Fertilizer Management Division, Ph. 651-201-6379 Fax 651-201-6112
Minn. Stat. Sec. 18C.411
20______APPLICATION FOR SOIL/PLANT AMENDMENT PRODUCT REGISTRATION
License Period of January 1 to December 31
Do you currently hold a Minnesota Soil/Plant Amendment Product Registration Number:
No
Yes
If yes, MN Lic. No:__________________
GUARANTOR AS LABELED IN MINNESOTA (Complete below)
REGISTRANT (Complete if different from Guarantor)
Legal Name:
Legal Name:
DBA (if different):
DBA (if different):
Street Address:
Mailing Address:
City:
State:
City:
State:
Zip Code:
Zip Code:
Company Telephone:
Company Telephone:
COMPLETE BRAND NAME OF SOIL AND PLANT AMENDMENT
ITEM
Product registration WILL NOT be granted until product label/label fascimile and material used in promoting the sale of each product is
NO.
submitted with application.
1
2
3
4
5
6
7
8
9
10
Application Fees:
$__________________
Number of New Products ____________ X $200.00 each
Total Amount Due
600296(3100)
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Registrations are not transferable and fees are not refundable.
For Office Use Only
I hereby certify that the information contained in and submitted with this form is true and correct.
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
AG-00890 (11/14)
call the Minnesota Relay Service at 711 or 1-800-627-3529. The MDA is an equal opportunity employer and provider.