"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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RUPDLNo.:
STATE OF NEV ADA
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, _________. Remittance payable to Nevada Department of Agriculture in amount of $25.00 is enclosed
herewith.
Renewal applications received after February 1 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 I COMPANY NAME & ADDRESS:
Attention:
Telephone:
Fax:
E-Mail:
AGENT
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 of2 years on all sales ofrestricted-use pesticides on forms
supplied by the Nevada Department of Agriculture.
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RUPDLNo.:
STATE OF NEV ADA
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, _________. Remittance payable to Nevada Department of Agriculture in amount of $25.00 is enclosed
herewith.
Renewal applications received after February 1 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 I COMPANY NAME & ADDRESS:
Attention:
Telephone:
Fax:
E-Mail:
AGENT
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 of2 years on all sales ofrestricted-use pesticides on forms
supplied by the Nevada Department of Agriculture.
Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Dat . ..,_ _ _ _ _ _ _ _ _ _ _ _
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Nam..__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Title. _ _ _ _ _ _ _ _ _ _ _
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