Form SFN 52023 Application for Wool Dealer's License - North Dakota

Form SFN52023 or the "Application For Wool Dealer's License" is a form issued by the North Dakota Department of Agriculture.

The form was last revised in December 1, 2013 and is available for digital filing. Download an up-to-date Form SFN52023 in PDF-format down below or look it up on the North Dakota Department of Agriculture Forms website.

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APPLICATION FOR WOOL DEALER'S LICENSE
600 E Boulevard Ave - Dept 602
NORTH DAKOTA DEPARTMENT OF AGRICULTURE
Bismarck ND 58505-0020
LIVESTOCK DIVISION
LICENSE FEE $10.00
SFN 52023 (12-2013)
License Expires June 30th
1. The undersigned is applying for a license as a dealer in wool under the provisions of the laws of the State of North Dakota.
(NDCC Ch. 4.1-88)
Name of Dealer
Mailing Address
City
State
ZIP Code
Telephone Number
2.
PLEASE NOTE: A dealer shall be accountable and responsible for all the acts of a designated agent (NDCC 4.1-88-13(2)). The
APPLICANT designates the following person(s) as agents to act in his behalf and requests that Agent Identification be issued to:
NAME
ADDRESS
I, the undersigned applicant for a North Dakota wool dealer's license, understand that I am strictly responsible for and will be held
strictly liable for all the acts, omissions, or failures arising out of wool dealings of the agent(s) listed above, whether or not the
dealings have been personally authorized by me.
X
Applicant's Signature
3.
A surety bond is required for each dealer. (NDCC 4.1-88-07) The surety bond is for the purpose of protecting any person who
deals with the dealer. It is for the benefit of any person selling wool to or dealing in wool with the dealer or the dealer's agent.
The minimum of the bond is $10,000. The department may require additional amounts to protect the public interest.
4. IF APPLICANT is a partnership, list name and address of the partners:
NAME
ADDRESS
5. IF APPLICANT is a corporation, or association, list name and address of the principal officers:
TITLE
NAME
ADDRESS
PRESIDENT
SECRETARY
TREASURER
GENERAL MANAGER
6. IF APPLICANT is a foreign corporation, where is principal place of business outside of North Dakota?
Mailing Address
City
State
ZIP Code
7. COMPLETE, DATE AND SIGN THE ENCLOSED FINANCIAL STATEMENT. (See enclosed Financial Statement)
(OVER)
APPLICATION FOR WOOL DEALER'S LICENSE
600 E Boulevard Ave - Dept 602
NORTH DAKOTA DEPARTMENT OF AGRICULTURE
Bismarck ND 58505-0020
LIVESTOCK DIVISION
LICENSE FEE $10.00
SFN 52023 (12-2013)
License Expires June 30th
1. The undersigned is applying for a license as a dealer in wool under the provisions of the laws of the State of North Dakota.
(NDCC Ch. 4.1-88)
Name of Dealer
Mailing Address
City
State
ZIP Code
Telephone Number
2.
PLEASE NOTE: A dealer shall be accountable and responsible for all the acts of a designated agent (NDCC 4.1-88-13(2)). The
APPLICANT designates the following person(s) as agents to act in his behalf and requests that Agent Identification be issued to:
NAME
ADDRESS
I, the undersigned applicant for a North Dakota wool dealer's license, understand that I am strictly responsible for and will be held
strictly liable for all the acts, omissions, or failures arising out of wool dealings of the agent(s) listed above, whether or not the
dealings have been personally authorized by me.
X
Applicant's Signature
3.
A surety bond is required for each dealer. (NDCC 4.1-88-07) The surety bond is for the purpose of protecting any person who
deals with the dealer. It is for the benefit of any person selling wool to or dealing in wool with the dealer or the dealer's agent.
The minimum of the bond is $10,000. The department may require additional amounts to protect the public interest.
4. IF APPLICANT is a partnership, list name and address of the partners:
NAME
ADDRESS
5. IF APPLICANT is a corporation, or association, list name and address of the principal officers:
TITLE
NAME
ADDRESS
PRESIDENT
SECRETARY
TREASURER
GENERAL MANAGER
6. IF APPLICANT is a foreign corporation, where is principal place of business outside of North Dakota?
Mailing Address
City
State
ZIP Code
7. COMPLETE, DATE AND SIGN THE ENCLOSED FINANCIAL STATEMENT. (See enclosed Financial Statement)
(OVER)
SFN 52023 (12-2013)
Page 2 of 2
8. REFERENCES:
List ALL banks/financial institutions, others who hold assets or liabilities of the applicant. Be sure to list the mailing address:
NAME
ADDRESS
List names of commodities broker(s) with whom the applicant has dealings (if none, write "NONE" in Name column):
NAME
ADDRESS
List names of accountants and other sources of information or references relating to the applicants business:
NAME
ADDRESS
9. Has applicant ever been convicted of violating the laws of this state governing the shipment of
Yes
No
transportation of wool?
Has applicant ever been convicted of fraudulent practices in the purchase of wool or dealing with wool?
Yes
No
The applicant voluntarily authorizes the Department of Agriculture, or its duly authorized agent, access to inspect and to copy any and all financial information
and records of the applicant held by those persons, institutions, and agencies identified in "REFERENCES" section of this application above and any other
institutions that may be required. The information and records may be used by the Department of Agriculture in the course of licensing, relicensing, or
investigation of any alleged violation of NDCC ch. 4.1-88. Any information or records gained through use of this release are confidential. Any disclosure of
information or records gained through the use of this release, except as provided for in this application, is prohibited. The Department of Agriculture may,
however, furnish the information or records gained through use of this release to the Attorney General and other state agencies, and any prosecuting officials
requiring the information or records for use in pursuit of official duties. This authorization remains in effect until the applicant provides specific revocation by
written notice to the Department of Agriculture.
NOTE: If APPLICANT is an association or
corporation, the association or corporate
name must be listed as the
APPLICANT.
X
Applicant's Signature
STATE OF
)
) SS.
By
COUNTY OF
)
Signature of Manager of Association or Corporation
, being duly sworn, says that he/she is the person named in the
foregoing application, or the manager of the corporation or partnership so named, and that the facts stated in this application are true
Sworn to before me this
day of
, 20
(Seal)
Notary Public
My commission expires
Deposit of license fee does not imply approval of application. Refunds will be issued for applications not approved.

Download Form SFN 52023 Application for Wool Dealer's License - North Dakota

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