Form AG-00163 "Screenings Permit Application" - Minnesota

What Is Form AG-00163?

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 April 17, 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-00163 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-00163 "Screenings Permit Application" - Minnesota

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Plant Protection Division, Ph: 651-201-6309, Fx: 651-201-6108
Screenings Permit Application
(Entry, inspection, and sampling by authority of M. S. 21.75)
for office use only
The data you supply on this form will be used to process your application. You are not legally
required to provide this data, but we will not be able to issue the permit without it. The ap-
:
permit yr
plication data will constitute a public record if and when the permit is issued and anyone may
:
request copies of this application data at that time. [M. S. 13.27, subd. 1(b)]
permit no
Person Applying For Permit
applicant name
phone
address
date
city
state
zip
Primary Firm Where Screenings Will Be Purchased
firm name
phone
address
city
state
zip
Secondary Firm Where Screenings Will Be Purchased
firm name
phone
address
city
state
zip
Secondary Firm Where Screenings Will Be Purchased
firm name
phone
address
city
state
zip
Description of devitalization process:
By authority of the Commissioner of Agriculture provided in M. S. 21.74, part (5), permission is granted to the applicant to
purchase screenings or grain containing weed seeds in excess of that permitted under M. S. 21.72, subdivision 15 and M. S.
21.73, subdivision 1, to be used for feed purposes from the firms identified in this application.
7
Applicant’s Signature ______________________________________________________________________________
AG-00163
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling
04/17/13
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.
Plant Protection Division, Ph: 651-201-6309, Fx: 651-201-6108
Screenings Permit Application
(Entry, inspection, and sampling by authority of M. S. 21.75)
for office use only
The data you supply on this form will be used to process your application. You are not legally
required to provide this data, but we will not be able to issue the permit without it. The ap-
:
permit yr
plication data will constitute a public record if and when the permit is issued and anyone may
:
request copies of this application data at that time. [M. S. 13.27, subd. 1(b)]
permit no
Person Applying For Permit
applicant name
phone
address
date
city
state
zip
Primary Firm Where Screenings Will Be Purchased
firm name
phone
address
city
state
zip
Secondary Firm Where Screenings Will Be Purchased
firm name
phone
address
city
state
zip
Secondary Firm Where Screenings Will Be Purchased
firm name
phone
address
city
state
zip
Description of devitalization process:
By authority of the Commissioner of Agriculture provided in M. S. 21.74, part (5), permission is granted to the applicant to
purchase screenings or grain containing weed seeds in excess of that permitted under M. S. 21.72, subdivision 15 and M. S.
21.73, subdivision 1, to be used for feed purposes from the firms identified in this application.
7
Applicant’s Signature ______________________________________________________________________________
AG-00163
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling
04/17/13
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.