Form FS-5105 "Shell Egg/Processed Egg Dealer License New, Renewal or Cancellation Application" - Oklahoma

What Is Form FS-5105?

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

Form Details:

  • Released on February 1, 2007;
  • The latest edition provided by the Oklahoma Department of Agriculture Food and Forestry;
  • 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 FS-5105 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Agriculture Food and Forestry.

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Download Form FS-5105 "Shell Egg/Processed Egg Dealer License New, Renewal or Cancellation Application" - Oklahoma

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FS-5105
Rev. 2-07
OFFICE USE ONLY
Oklahoma Department of Agriculture, Food & Forestry
DATE:
FOOD SAFETY DIVISION
Poultry, Egg & Organic Foods Section
RECEIPT NO:
P.O. Box 528804
Oklahoma City, OK 73152-8804
AMOUNT-$
PH: (405)522-5924
FAX: (405)522-1060
REV CODE-379
SHELL EGG / PROCESSED EGG
DEALER LICENSE NEW, RENEWAL OR CANCELLATION APPLICATION
ANNUAL LICENSE EGG DEALERS - $35.00
NOTE: Each location requires a separate license and application.
Egg Dealers Licenses are not transferable.
Please check the appropriate box, fill out completely, sign and return the entire form
PLEASE RENEW MY LICENSE
NEW OWNER/ISSUE NEW LICENSE
NEW DEALER
NO LONGER IN BUSINESS
NO LONGER DISTRIBUTING EGGS
OWNERS NAME
PHONE:
(
)
LOCATION NAME:
PHONE:
(
)
LOCATION ADDRESS:
COUNTY:
CITY:
STATE:
ZIP CODE:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
In signing this application, I understand and agree to comply with the Oklahoma Egg Law 2 O.S. §10-81 to keep such
records, make such reports and pay such fees as required. I agree to make such records available and authorize
permission and access to such records to the Board or its authorized representative any time during normal business
hours.
Signature of Applicant
Date
PLEASE MAKE CHECK PAYABLE TO OKLAHOMA DEPARTMENT OF AGRICULTURE, FOOD & FORESTRY
ADDRESS ENVELOPE ATTENTION FOOD SAFETY DIVISION: POULTRY, EGG & ORGANIC FOODS SECTION
FS-5105
Rev. 2-07
OFFICE USE ONLY
Oklahoma Department of Agriculture, Food & Forestry
DATE:
FOOD SAFETY DIVISION
Poultry, Egg & Organic Foods Section
RECEIPT NO:
P.O. Box 528804
Oklahoma City, OK 73152-8804
AMOUNT-$
PH: (405)522-5924
FAX: (405)522-1060
REV CODE-379
SHELL EGG / PROCESSED EGG
DEALER LICENSE NEW, RENEWAL OR CANCELLATION APPLICATION
ANNUAL LICENSE EGG DEALERS - $35.00
NOTE: Each location requires a separate license and application.
Egg Dealers Licenses are not transferable.
Please check the appropriate box, fill out completely, sign and return the entire form
PLEASE RENEW MY LICENSE
NEW OWNER/ISSUE NEW LICENSE
NEW DEALER
NO LONGER IN BUSINESS
NO LONGER DISTRIBUTING EGGS
OWNERS NAME
PHONE:
(
)
LOCATION NAME:
PHONE:
(
)
LOCATION ADDRESS:
COUNTY:
CITY:
STATE:
ZIP CODE:
MAILING ADDRESS:
CITY:
STATE:
ZIP CODE:
In signing this application, I understand and agree to comply with the Oklahoma Egg Law 2 O.S. §10-81 to keep such
records, make such reports and pay such fees as required. I agree to make such records available and authorize
permission and access to such records to the Board or its authorized representative any time during normal business
hours.
Signature of Applicant
Date
PLEASE MAKE CHECK PAYABLE TO OKLAHOMA DEPARTMENT OF AGRICULTURE, FOOD & FORESTRY
ADDRESS ENVELOPE ATTENTION FOOD SAFETY DIVISION: POULTRY, EGG & ORGANIC FOODS SECTION