Form DP-29 "Application for a Firm's Commercial Applicator License" - Arkansas

What Is Form DP-29?

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

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Arkansas Agriculture Department;
  • 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 DP-29 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form DP-29 "Application for a Firm's Commercial Applicator License" - Arkansas

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Form DP-29 (Rev. 10/18)
Application For a Firm’s Commercial Applicator License
Issued under the Authority of Act 389 of 1975,
Pesticide Use and Application Act
For the Year Ending December 31, 20___
INSTRUCTIONS: Complete and submit with appropriate fees to the Arkansas State Plant Board, P.O. Box 1069, Little
Rock, AR 72203. PRINT OR TYPE ONLY. Provide documentation as required.
Firm:
Mailing Address ___________________________________________
City:
State
Zip Code
County: __________________
Office Phone (
)
-
Fax (
)
-
Cell Phone (
)
-
(opt)
Contact Person
Phone
E-mail Address _______________________
Latitude
(dd mm ss.s’) and Longitude
(dd mm ss.s’) of the loading/mixing site
1. Out of State persons or firms - Attach Power of Attorney (forms enclosed) designating an Arkansas resident for service
of process.
2. Financial responsibility: $100,000 minimum required (if insurance, deductible not to exceed $5,000). Indicate the form
your firm will use and provide:
Letter of Credit
Surety Bond
Escrow Account
Insurance
;
;
;
;
3. LIST APPLICATION EQUIPMENT TO BE LICENSED AND USED:
Id # for Ground
ASPB’s
Air or Ground
Year
Type of Equipment (Make)
Model
or “N” for A/C
Assigned #
Ex:(Air or Grd)
(1990)
(Airtractor or Tyler Airflow)
(802 or 433)
(N1111 or # 10)
List the exact location in Arkansas (town, street address, firm name) where records of application will be kept for Plant
4.
Board inspection upon demand.
___________________________________________________________________________
Indicate All Licensed Certified applicator(s) that will be working under this license:
5.
_________________________________________________
________________________________________________
_________________________________________________
________________________________________________
6. Fees:
Commercial Application License ......................................................... $ 100.00
$ __________________
Aircraft and/or article of ground equipment ......................................... $ 20.00 each $ __________________
Total Fees Enclosed $ __________________
I hereby certify that: the above representations and attachments are true and correct; that financial responsibility will be
maintained for the term of the license; that all applicators will possess the proper Plant Board credentials; and that I have
read and am familiar with the Pesticide Use and Application Act and the regulation adopted thereunder.
Applicant’s
Name (Printed)
Signature _________________________________
Title
Date
_________________________________
*****************************************************************************************
DO NOT WRITE IN THIS SPACE
________________________
_________________________
License Number
Date of Issuance
Form DP-29 (Rev. 10/18)
Application For a Firm’s Commercial Applicator License
Issued under the Authority of Act 389 of 1975,
Pesticide Use and Application Act
For the Year Ending December 31, 20___
INSTRUCTIONS: Complete and submit with appropriate fees to the Arkansas State Plant Board, P.O. Box 1069, Little
Rock, AR 72203. PRINT OR TYPE ONLY. Provide documentation as required.
Firm:
Mailing Address ___________________________________________
City:
State
Zip Code
County: __________________
Office Phone (
)
-
Fax (
)
-
Cell Phone (
)
-
(opt)
Contact Person
Phone
E-mail Address _______________________
Latitude
(dd mm ss.s’) and Longitude
(dd mm ss.s’) of the loading/mixing site
1. Out of State persons or firms - Attach Power of Attorney (forms enclosed) designating an Arkansas resident for service
of process.
2. Financial responsibility: $100,000 minimum required (if insurance, deductible not to exceed $5,000). Indicate the form
your firm will use and provide:
Letter of Credit
Surety Bond
Escrow Account
Insurance
;
;
;
;
3. LIST APPLICATION EQUIPMENT TO BE LICENSED AND USED:
Id # for Ground
ASPB’s
Air or Ground
Year
Type of Equipment (Make)
Model
or “N” for A/C
Assigned #
Ex:(Air or Grd)
(1990)
(Airtractor or Tyler Airflow)
(802 or 433)
(N1111 or # 10)
List the exact location in Arkansas (town, street address, firm name) where records of application will be kept for Plant
4.
Board inspection upon demand.
___________________________________________________________________________
Indicate All Licensed Certified applicator(s) that will be working under this license:
5.
_________________________________________________
________________________________________________
_________________________________________________
________________________________________________
6. Fees:
Commercial Application License ......................................................... $ 100.00
$ __________________
Aircraft and/or article of ground equipment ......................................... $ 20.00 each $ __________________
Total Fees Enclosed $ __________________
I hereby certify that: the above representations and attachments are true and correct; that financial responsibility will be
maintained for the term of the license; that all applicators will possess the proper Plant Board credentials; and that I have
read and am familiar with the Pesticide Use and Application Act and the regulation adopted thereunder.
Applicant’s
Name (Printed)
Signature _________________________________
Title
Date
_________________________________
*****************************************************************************************
DO NOT WRITE IN THIS SPACE
________________________
_________________________
License Number
Date of Issuance