Form FMC-10 "Supplier List" - New York

What Is Form FMC-10?

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 January 3, 2018;
  • 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 fillable version of Form FMC-10 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 FMC-10 "Supplier List" - New York

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Farmers’ Market Nutrition Program (FMNP)
Rev 1/3/2018
SUPPLIER LIST (FMC-10)
Clear Form
Instructions: Fill in the information below for every fruit and vegetable supplier (business) anticipated to
supply/is currently supplying this market during either the FMNP season (June 1 – November 30), or from the
market’s opening day to closing day, whichever is the shorter. The supplier information should be specific to
each market day and location. For example, if the market operates on Tuesday and Thursday, submit a separate
supplier list for each market day. Examples of fruit and vegetable businesses can include farmers (growers),
dealers, distributors, food hubs, etc. If more room is needed, make copies of this form.
Market Name: _____________________________________ Day: ☐Mo ☐Tu ☐We ☐Th ☐Fr ☐Sa ☐Su
☐ Yes ☐ No ☐ In-Progress
Is the market operated/sponsored by a private nonprofit agency?
Business Name (#1): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#2): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#3): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Signature of Applicant. I acknowledge that I have read and agree to abide by the NYS FMNP “Rules and
Procedures for Markets (FMC-4)” provided by the NYS Department of Agriculture and Markets. By signing
below, I certify that all information is true and correct to the best of my knowledge.
Signature (required): ______________________________________________________ Date: __________
Print Name: ______________________________________________Title: ___________________________
Submit to:
NYS Dept. of Agriculture and Markets Attention: FMNP
Fax: (518) 457-8398
10B Airline Drive Albany NY 12235
Email:
farmersmarkets@agriculture.ny.gov
Questions?
Albany: (518) 457-7076 prompt #1
Toll Free: (800) 554-4501
This institution is an equal opportunity provider.
Farmers’ Market Nutrition Program (FMNP)
Rev 1/3/2018
SUPPLIER LIST (FMC-10)
Clear Form
Instructions: Fill in the information below for every fruit and vegetable supplier (business) anticipated to
supply/is currently supplying this market during either the FMNP season (June 1 – November 30), or from the
market’s opening day to closing day, whichever is the shorter. The supplier information should be specific to
each market day and location. For example, if the market operates on Tuesday and Thursday, submit a separate
supplier list for each market day. Examples of fruit and vegetable businesses can include farmers (growers),
dealers, distributors, food hubs, etc. If more room is needed, make copies of this form.
Market Name: _____________________________________ Day: ☐Mo ☐Tu ☐We ☐Th ☐Fr ☐Sa ☐Su
☐ Yes ☐ No ☐ In-Progress
Is the market operated/sponsored by a private nonprofit agency?
Business Name (#1): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#2): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#3): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Signature of Applicant. I acknowledge that I have read and agree to abide by the NYS FMNP “Rules and
Procedures for Markets (FMC-4)” provided by the NYS Department of Agriculture and Markets. By signing
below, I certify that all information is true and correct to the best of my knowledge.
Signature (required): ______________________________________________________ Date: __________
Print Name: ______________________________________________Title: ___________________________
Submit to:
NYS Dept. of Agriculture and Markets Attention: FMNP
Fax: (518) 457-8398
10B Airline Drive Albany NY 12235
Email:
farmersmarkets@agriculture.ny.gov
Questions?
Albany: (518) 457-7076 prompt #1
Toll Free: (800) 554-4501
This institution is an equal opportunity provider.
Farmers’ Market Nutrition Program (FMNP)
Rev 1/3/2018
SUPPLIER LIST (FMC-10)
Business Name (#4): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#5): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#6): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#7): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#8): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
Business Name (#9): _______________________________________________________________________
Owner’s First and Last Name(s): ______________________________________________________________
Business Address: __________________________________________________________ Zip: ___________
If the farm is participating in the FMNP, indicate the following:
☐ N/A, this supplier is not an FMNP farm.
FMNP Stamp ID: ______ Acreage Cultivated in Fruits/Vegetables: ____ Farm’s Total Tillable Acreage: ____
This institution is an equal opportunity provider.
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