Form DMC-1514 "Application for Permit to Ship Milk or Milk Products Into New York State" - New York

What Is Form DMC-1514?

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

Form Details:

  • Released on May 1, 2009;
  • The latest edition provided by the New York State Department of Agriculture and Markets;
  • 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 DMC-1514 by clicking the link below or browse more documents and templates provided by the New York State Department of Agriculture and Markets.

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Download Form DMC-1514 "Application for Permit to Ship Milk or Milk Products Into New York State" - New York

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DMC-1514 (5/09)
Indicate Type of Facility/Operation:
New York State
Pasteurizing or Mfg. Plant:
Department of Agriculture & Markets
Receiving/Transfer Station:
Division of Milk Control & Dairy Services
Bulk Tank Unit:
10 B Airline Drive
Plant/BTU Number:
Albany, New York 12235
Milk Distributor:
Tel. 518-457-5731
APPLICATION FOR PERMIT TO SHIP MILK OR MILK PRODUCTS INTO NEW YORK STATE
(For the one-year period July 1 - June 30)
(Full legal name as it appears on filing documents. If business type is "individual",
Phone No.
(1) Name
must be person's name)
Fax No.
(2) Trade Name (if applicable)
(3) Fed ID or SS# (if individual)
(4) Mailing Address
Website:
(5) Location Address for Type of Facility/Operation Indicated Above (if same as mailing address, mark same)
(6) Business Type:
Individual
General Partnership
Limited Partnership
Corporation
Limited Liability Co. (LLC)
Cooperative
(7) List Officers of Corporation or Cooperative and Members of Partnership or LLC:
Full Name
Title/Position
Full Name
Title/Position
In what State Incorporated//Organized _________ Date Incorporated//Organized _________
(8) If Applicant is a
Principal Office Address _______________________________________________________
Corporation//LLC
If a foreign corporation//LLC, are you authorized under Section 1304 & 1305 of the Business
Corporation Law//Section 802 & 805 of the Limited Liability Company Law to do business in
the State of New York? ____ yes ____ no If yes, date filed _________
Name and address of a person in New York State upon whom service of process may
be made? __________________________________________________________________
(9) List or attach copy of products to be
Pasteurized Milk
shipped into New York State:
Pasteurized Milk
Milk Products
(list types)
DMC-1514 (5/09)
Indicate Type of Facility/Operation:
New York State
Pasteurizing or Mfg. Plant:
Department of Agriculture & Markets
Receiving/Transfer Station:
Division of Milk Control & Dairy Services
Bulk Tank Unit:
10 B Airline Drive
Plant/BTU Number:
Albany, New York 12235
Milk Distributor:
Tel. 518-457-5731
APPLICATION FOR PERMIT TO SHIP MILK OR MILK PRODUCTS INTO NEW YORK STATE
(For the one-year period July 1 - June 30)
(Full legal name as it appears on filing documents. If business type is "individual",
Phone No.
(1) Name
must be person's name)
Fax No.
(2) Trade Name (if applicable)
(3) Fed ID or SS# (if individual)
(4) Mailing Address
Website:
(5) Location Address for Type of Facility/Operation Indicated Above (if same as mailing address, mark same)
(6) Business Type:
Individual
General Partnership
Limited Partnership
Corporation
Limited Liability Co. (LLC)
Cooperative
(7) List Officers of Corporation or Cooperative and Members of Partnership or LLC:
Full Name
Title/Position
Full Name
Title/Position
In what State Incorporated//Organized _________ Date Incorporated//Organized _________
(8) If Applicant is a
Principal Office Address _______________________________________________________
Corporation//LLC
If a foreign corporation//LLC, are you authorized under Section 1304 & 1305 of the Business
Corporation Law//Section 802 & 805 of the Limited Liability Company Law to do business in
the State of New York? ____ yes ____ no If yes, date filed _________
Name and address of a person in New York State upon whom service of process may
be made? __________________________________________________________________
(9) List or attach copy of products to be
Pasteurized Milk
shipped into New York State:
Pasteurized Milk
Milk Products
(list types)
(10) If applicant is a Plant, Receiving/Transfer Station or BTU:
(a) Are you currently listed in the "Sanitation Compliance and Enforcement Ratings of Interstate Milk Shippers" (IMS)?
_____ Yes
(If yes, plant/BTU number)
____________________
_____ NO
(b) If not listed in IMS:
(1) enclose a copy of the most recent Sanitary Inspection Report of the facility by the responsible regulatory
agency in your state
(2) Indicate the name of the regulatory agency ___________________________________________________,
contact person ______________________________________ and tel. number (____)_____________________
(3) With respect to the milk and milk products to be imported into New York State, are any from a foreign
(outside of the United States) source or contain any dairy ingredient from a foreign source? ____ yes ____ no
If yes, complete the following:
Product/Ingredient
Name and Address of Manufacturer
Note: For products listed as from a foreign source, the applicant must complete DMC-1514 Supplemental
Questionaire, which shall become a part of this application.
(11) If applicant is a Milk Distributor:
List the source of the milk and milk products that you intend to import into NYS:
(a) Directly from Plants
IMS Listed
Name and Address
No
Yes (Plt No.)
(b) From Distributors/Handlers (attach additional pages if needed) Corresponding Plant Source
Name:
Name:
Address:
Address:
Name:
Name:
Address:
Address:
Name:
Name:
Address:
Address:
(c) Are any of the milk and milk products to be imported into NYS from a foreign (outside of the United States)
source? ____ No
_____ Yes (If yes, complete the following):
Product
Name and Address of Manufacturer
Note: For products listed as from a foreign source, the applicant must complete DMC-1514 Supplemental
Questionaire, which shall become a part of this application.
(12) For all applicants, list or attach a copy of the name and address of plants, warehouses, distributors and other outlets in
NYS to whom you intend to ship imported milk and milk products to during the license period.
Name
Address
NOTE:
DMC-1514 Supplemental Questionaire can be accessed from our website at www.agmkt.ny.state.us; click on Milk
Control and Dairy Services Division or call us at 518-457-5731.
In addition to this PERMIT, a person doing business as a MILK DEALER, which involves the buying, selling,
handling or transporting of fluid milk (such as whole milk, reduced fat milk, lowfat milk, fat-free milk, flavored milk)
and fluid cream (such as half and half, light cream, heavy cream) products, are required by law to be licensed
pursuant to NYS AGRICULTURE AND MARKETS LAW, SECTION 257. For additional information, visit our website
or call per above.
The authority to request information contained in this document is found in Section 16 of the Agriculture and Markets Law and the specific
section or sections of that Law which relate to the license, permit, certificate, approval, registration or permission which you seek. The
principal purpose for information collected is to enable the Department of Agriculture and Markets to determine whether or not to issue the
requested license, permit, certificate, approval, registration or permission. This information will be used by the Department of Agriculture
and Markets for the purpose of evaluating your application and enforcing and administering the Agriculture and Markets Law.
Disclosure of your federal social security and federal employer identification numbers by you is mandatory and is authorized by Section 5 of
the Tax Law. The principal purpose for which information is collected is to enable the Department of Taxation and Finance to identify
individuals, businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally
identify persons affected by the Tax Law administered by the Commissioner of Taxation and Finance for administering the Tax Law and for
any other purpose authorized by the Tax Law.
The applicant is familiar with all Regulations relevant to this facility/operation and agrees to comply with all
applicable requirements. Milk or milk products to be imported into New York State will be obtained only from the
sources listed above.
Authorized Signature:
Print Name:
Title:
Date:
Contact Person:
Tel:
E-mail:
Should you fail to provide all of the requested information, your application may not be processed.
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