Form AES-23-03 "Place of Business Permit" - Louisiana

What Is Form AES-23-03?

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

Form Details:

  • Released on May 1, 2018;
  • The latest edition provided by the Louisiana Department of Agriculture & 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 fillable version of Form AES-23-03 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Agriculture & Forestry.

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Download Form AES-23-03 "Place of Business Permit" - Louisiana

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L
D
A
F
OUISIANA
EPARTMENT OF
GRICULTURE &
ORESTRY
M
S
, C
DVM
IKE
TRAIN
OMMISSIONER
Structural Pest Control Commission, 5825 Florida Blvd., Suite 3003, Baton Rouge, LA 70806, (225) 925-4578, FAX (225) 923-4878
*2303*
PLACE OF BUSINESS PERMIT
ANNUAL FEE
$150 – 2 or fewer licensed pest control operators and/or technicians
$200 – 3 or more licensed pest control operators and/or technicians
INITIAL
All information must be typed or printed
RENEWAL
Name of Business
Federal Tax ID #
Business LDAF ID #
Mailing Address
Phone #
City, State, Zip
Fax #
Physical Address
Contact Name
E-mail
LDAF ID #
Check Phase(s) of License
LOUISIANA STRUCTURAL PEST CONTROL LICENSEES
$10 per phase
(
) Check Primary Licensee
Name
LDAF #
1
2
3
4
5
6
Fee
$
$
$
Additional Page Total
$
Total
$
Check Phase(s) of Registration
TECHNICIANS
$25 Fee for each Technician listed
Technicians must be registered by the Place of Business
Name
LDAF #
1
2
3
4
5
6
Fee
$
$
$
Additional Page Total
$
If you have more technicians than space allows, please continue on a separate piece of paper, listing all required information, or with the
additional page available on the department website.
Total
$
Phases: 1. General Pest Control
2. Commercial Vertebrate Control
3. Termite Control
4. Structural Fumigation
5. Ship Fumigation
6. Commodity Fumigation
Note: Phases must correspond to those phases for which the technician is registered, not to exceed those of the supervising licensee, when
engaging in pest control work.
******Please return this form & remittance to:******
Louisiana Department of Agriculture & Forestry
I (we) do hereby apply for Place of Business permit in accordance with R.S. 3:3367 &
agree to keep records as required in R.S. 3:3369 (1)
5825 Florida Blvd. Suite 1003
Baton Rouge LA 70806
Licensee Signature ______________________________________________
OFFICE USE ONLY:
Name _________________________________________________________
LDAF ID NO.:____________________
__________________________________________________________
Date
DATE ISSUED: __________________
Amount of Remittance $__________________________________________
OFFICE USE
Transmittal #
PLACE OF BUSINESS
0600 1595 03 $__________.
Check #
LICENSE OPERATOR
0600 1595 04 $__________.
Date
.
TECHNICIANS
0600 1595 05 $__________.
Amt. $
AES-23-03 (R. 5/18)
L
D
A
F
OUISIANA
EPARTMENT OF
GRICULTURE &
ORESTRY
M
S
, C
DVM
IKE
TRAIN
OMMISSIONER
Structural Pest Control Commission, 5825 Florida Blvd., Suite 3003, Baton Rouge, LA 70806, (225) 925-4578, FAX (225) 923-4878
*2303*
PLACE OF BUSINESS PERMIT
ANNUAL FEE
$150 – 2 or fewer licensed pest control operators and/or technicians
$200 – 3 or more licensed pest control operators and/or technicians
INITIAL
All information must be typed or printed
RENEWAL
Name of Business
Federal Tax ID #
Business LDAF ID #
Mailing Address
Phone #
City, State, Zip
Fax #
Physical Address
Contact Name
E-mail
LDAF ID #
Check Phase(s) of License
LOUISIANA STRUCTURAL PEST CONTROL LICENSEES
$10 per phase
(
) Check Primary Licensee
Name
LDAF #
1
2
3
4
5
6
Fee
$
$
$
Additional Page Total
$
Total
$
Check Phase(s) of Registration
TECHNICIANS
$25 Fee for each Technician listed
Technicians must be registered by the Place of Business
Name
LDAF #
1
2
3
4
5
6
Fee
$
$
$
Additional Page Total
$
If you have more technicians than space allows, please continue on a separate piece of paper, listing all required information, or with the
additional page available on the department website.
Total
$
Phases: 1. General Pest Control
2. Commercial Vertebrate Control
3. Termite Control
4. Structural Fumigation
5. Ship Fumigation
6. Commodity Fumigation
Note: Phases must correspond to those phases for which the technician is registered, not to exceed those of the supervising licensee, when
engaging in pest control work.
******Please return this form & remittance to:******
Louisiana Department of Agriculture & Forestry
I (we) do hereby apply for Place of Business permit in accordance with R.S. 3:3367 &
agree to keep records as required in R.S. 3:3369 (1)
5825 Florida Blvd. Suite 1003
Baton Rouge LA 70806
Licensee Signature ______________________________________________
OFFICE USE ONLY:
Name _________________________________________________________
LDAF ID NO.:____________________
__________________________________________________________
Date
DATE ISSUED: __________________
Amount of Remittance $__________________________________________
OFFICE USE
Transmittal #
PLACE OF BUSINESS
0600 1595 03 $__________.
Check #
LICENSE OPERATOR
0600 1595 04 $__________.
Date
.
TECHNICIANS
0600 1595 05 $__________.
Amt. $
AES-23-03 (R. 5/18)
Check Phase(s) of License
LOUISIANA STRUCTURAL PEST CONTROL LICENSEES
$10 per phase
(
) Check Primary Licensee
Name
LDAF #
1
2
3
4
5
6
Fee
$
$
$
$
$
Total
$
Check Phase(s) of Registration
TECHNICIANS
$25 Fee for each Technician listed
Technicians must be registered by the Place of Business
Name
LDAF #
1
2
3
4
5
6
Fee
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Total
$
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