"Application for Certificate of Free Sale" - Nevada

Application for Certificate of Free Sale is a legal document that was released by the Nevada Department of Agriculture - a government authority operating within Nevada.

Form Details:

  • The latest edition currently provided by the Nevada Department of Agriculture;
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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Agriculture.

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Application for Certificate of Free Sale
Administration Division
This application is for:
 Agricultural product*: (Fee for certificate = $25.00/certificate)
 Dairy product: (Fee for certificate = $25.00/certificate)
Company Name: _______________________________________________________________
Address: _____________________________________________________________________
City: _____________________________ State: ________________ Zip: _________________
Address where product is manufactured: __________________________________________
City: _____________________________ State: ________________ Zip: _________________
Product(s) name & description
(A separate list may be attached): __________________________________________________
Shipping point: ________________________________________________________________
Country of destination: _________________________________________________________
 Product is food for human consumption
 Product is a food for livestock consumption
Do you want the certificate to be notarized? ___Yes ___No
I, ______________________________ certify to the Department that the product(s) listed above
is grown/processed in the state of Nevada with the same formula and standards used when said
product(s) is offered for sale and sold in the United States, and that said product is readily available
for sale in the United States without restriction.
___________________________________
___________________________________
Business Representative Signature
Business Representative Name (print)
Dated at _________________________ Nevada, this _________ day of _____________ 20____
Send certificate to:
Bill certificate to:
__Email:______________________
__Pick up at the Sparks NDA office
__Fed Ex. (# required):___________
(Address)______________________
__Phone #_____________________
Send applications to Jeff Sutich:
jssutich@agri.nv.gov
or call at 775-353-3627
*Note: “Agriculture product” means a product of the soil, a farm products and any product
commonly used to enhance agricultural production, including, without limitation, a products
produced by hydroponic or aquatic farming.
page | 1
Application for Certificate of Free Sale
Administration Division
This application is for:
 Agricultural product*: (Fee for certificate = $25.00/certificate)
 Dairy product: (Fee for certificate = $25.00/certificate)
Company Name: _______________________________________________________________
Address: _____________________________________________________________________
City: _____________________________ State: ________________ Zip: _________________
Address where product is manufactured: __________________________________________
City: _____________________________ State: ________________ Zip: _________________
Product(s) name & description
(A separate list may be attached): __________________________________________________
Shipping point: ________________________________________________________________
Country of destination: _________________________________________________________
 Product is food for human consumption
 Product is a food for livestock consumption
Do you want the certificate to be notarized? ___Yes ___No
I, ______________________________ certify to the Department that the product(s) listed above
is grown/processed in the state of Nevada with the same formula and standards used when said
product(s) is offered for sale and sold in the United States, and that said product is readily available
for sale in the United States without restriction.
___________________________________
___________________________________
Business Representative Signature
Business Representative Name (print)
Dated at _________________________ Nevada, this _________ day of _____________ 20____
Send certificate to:
Bill certificate to:
__Email:______________________
__Pick up at the Sparks NDA office
__Fed Ex. (# required):___________
(Address)______________________
__Phone #_____________________
Send applications to Jeff Sutich:
jssutich@agri.nv.gov
or call at 775-353-3627
*Note: “Agriculture product” means a product of the soil, a farm products and any product
commonly used to enhance agricultural production, including, without limitation, a products
produced by hydroponic or aquatic farming.
page | 1