"Application for Dealers License to Sell Restricted-Use Pesticides" - Nevada

Application for Dealers License to Sell Restricted-Use Pesticides is a legal document that was released by the Nevada Department of Agriculture - a government authority operating within Nevada.

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Download "Application for Dealers License to Sell Restricted-Use Pesticides" - Nevada

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RUPDL No.:
STATE OF NEVADA
DEPARTMENT OF AGRICULTURE
405 South 21st Street
Sparks, Nevada 89431
APPLICATION FOR DEALERS LICENSE TO SELL RESTRICTED-USE PESTICIDES
Application is hereby made for a permit to sell pesticides to consumers or users which are classified as restricted-use for calendar year
ending December 31, 20__. Remittance payable to Nevada Department of Agriculture in amount of $25.00 is enclosed herewith.
Renewal applications postmarked after February 1, of the prior registration year, require a penalty fee of $5.00, unless accompanied
by a statement that no restricted-use pesticides have been sold or distributed during the expired time period.
DEALER / COMPANY NAME & ADDRESS:
Attention:
Telephone:
Fax:
E-Mail:
Phone
Fax
Email
AGENT
CITY
STATE
I hereby certify that the information appearing on this application is true and correct; that each person licensed to sell resticted-use
pesticides to consumers or users will maintain and keep records for a period of 2 years on all sales of restricted-use pesticides on forms
supplied by the Nevada Department of Agriculture.
Signature
Date
Name
Title
RUPDL No.:
STATE OF NEVADA
DEPARTMENT OF AGRICULTURE
405 South 21st Street
Sparks, Nevada 89431
APPLICATION FOR DEALERS LICENSE TO SELL RESTRICTED-USE PESTICIDES
Application is hereby made for a permit to sell pesticides to consumers or users which are classified as restricted-use for calendar year
ending December 31, 20__. Remittance payable to Nevada Department of Agriculture in amount of $25.00 is enclosed herewith.
Renewal applications postmarked after February 1, of the prior registration year, require a penalty fee of $5.00, unless accompanied
by a statement that no restricted-use pesticides have been sold or distributed during the expired time period.
DEALER / COMPANY NAME & ADDRESS:
Attention:
Telephone:
Fax:
E-Mail:
Phone
Fax
Email
AGENT
CITY
STATE
I hereby certify that the information appearing on this application is true and correct; that each person licensed to sell resticted-use
pesticides to consumers or users will maintain and keep records for a period of 2 years on all sales of restricted-use pesticides on forms
supplied by the Nevada Department of Agriculture.
Signature
Date
Name
Title