Form 1440A "Mississippi Feed Facility Registration Form" - Mississippi

What Is Form 1440A?

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

Form Details:

  • The latest edition provided by the Mississippi Department of Agriculture and Commerce;
  • 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 1440A by clicking the link below or browse more documents and templates provided by the Mississippi Department of Agriculture and Commerce.

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Download Form 1440A "Mississippi Feed Facility Registration Form" - Mississippi

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PERMIT # :
Mississippi Department of Agriculture and Commerce
Bureau of Plant Industry
P.O. Box 5207
Mississippi State, Mississippi 39762-5207
Telephone: 1-888-257-1865 Email:
bpifflsp@mdac.ms.gov
DATE:
MISSISSIPPI FEED FACILITY REGISTRATION FORM
INSTRUCTIONS:
Select either NEW or RENEWAL feed facility registration, and provide company information.
The Federal Tax ID IS REQUIRED.
There is a $100 per facility registration fee
Complete online registration at
https://www.ms.gov/mdac/registration_suite
For manual processing, make checks payable to: Mississippi Department of Agriculture and Commerce &
Agriculture and mail to the address listed above.
SELECT ONE:
New Feed Facility
Renewal Feed Facility
1.
Company Name
2.
Location Name
(include DBA or other known names, if applicable)
3.
Federal Tax ID
4.
Company Mailing Address
5.
Company Physical Address
6.
Location Mailing Address
7.
Location Physical Address
8.
Telephone Number
Fax Number
9.
Email Address
10. Company Representative
11. Location Representative
12. Type of Business (1) Manufacturer
(2) Distributor
*(3) Integrated Operator/Contract Feeder
(4) Other (Specify)
*75-45-167(f) Mississippi Commercial Feed Law, Code of 1972
13. How long has the applicant been engaged in business for which permit is requested?
14. Approximate number of tons sold in Mississippi in the previous 12 months
Form #1440A
New Company Feed Facility Registration
PERMIT # :
Mississippi Department of Agriculture and Commerce
Bureau of Plant Industry
P.O. Box 5207
Mississippi State, Mississippi 39762-5207
Telephone: 1-888-257-1865 Email:
bpifflsp@mdac.ms.gov
DATE:
MISSISSIPPI FEED FACILITY REGISTRATION FORM
INSTRUCTIONS:
Select either NEW or RENEWAL feed facility registration, and provide company information.
The Federal Tax ID IS REQUIRED.
There is a $100 per facility registration fee
Complete online registration at
https://www.ms.gov/mdac/registration_suite
For manual processing, make checks payable to: Mississippi Department of Agriculture and Commerce &
Agriculture and mail to the address listed above.
SELECT ONE:
New Feed Facility
Renewal Feed Facility
1.
Company Name
2.
Location Name
(include DBA or other known names, if applicable)
3.
Federal Tax ID
4.
Company Mailing Address
5.
Company Physical Address
6.
Location Mailing Address
7.
Location Physical Address
8.
Telephone Number
Fax Number
9.
Email Address
10. Company Representative
11. Location Representative
12. Type of Business (1) Manufacturer
(2) Distributor
*(3) Integrated Operator/Contract Feeder
(4) Other (Specify)
*75-45-167(f) Mississippi Commercial Feed Law, Code of 1972
13. How long has the applicant been engaged in business for which permit is requested?
14. Approximate number of tons sold in Mississippi in the previous 12 months
Form #1440A
New Company Feed Facility Registration
PERMIT # :
Mississippi Department of Agriculture and Commerce
Bureau of Plant Industry
P.O. Box 5207
Mississippi State, Mississippi 39762-5207
Telephone: 1-888-257-1865 Email:
bpifflsp@mdac.ms.gov
DATE:
The undersigned applicant hereby agrees to keep such books and records as may be necessary to show accurately the tonnage and kind of
Commercial Feed sold and grants the Commissioner or his duly authorized representative permission to examine such books and records for the
purpose of verifying statements of tonnage and further, agrees to comply with the terms and conditions of the Mississippi Commercial Feed Law
and all regulations adopted thereunder.
This, the __________________day of ___________________________, 20_____
____________________________________________ By ____________________________________________
Full Name of Applicant (Business Name)
(Please Print)
Signature _______________________________________
Form #1440A
New Company Feed Facility Registration
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