Form FDACS-07155 "Annual Tomato Farm and Greenhouse Registration Application" - Florida

What Is Form FDACS-07155?

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

Form Details:

  • Released on October 1, 2013;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • 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 FDACS-07155 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-07155 "Annual Tomato Farm and Greenhouse Registration Application" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Fruit and Vegetables
ANNUAL TOMATO FARM AND GREENHOUSE
REGISTRATION APPLICATION
NICOLE "NIKKI" FRIED
Make check or money order payable to
COMMISSIONER
FDACS and remit with application to:
Rule 5G-6.007, F.A.C.
Division of Fruit and Vegetables
Phone: (863) 578-1947 or 1927
Office of License and Bond
(800) 782-3240 Ext 1947 or 1927
170 Century Blvd,
Bartow, Florida, 33830-9701
Attn: Bonds and Licenses
The Department of Agriculture and Consumer Services is the exclusive regulatory and permitting authority for any person, business or
corporation engaged in the farming of fresh tomatoes. Farming is defined as the growing and harvesting of fresh tomatoes for movement to a
packing house or other packing/repacking facility where final preparation and packing will be completed before distribution. REMIT
PERMIT COST OF $100.00 WITH APPLICATION.
INFORMATION ABOUT THE LOCATION TO BE REGISTERED
____ Renewal
_____ New Business
____ Corrected Information
____ Other
If other, please list here:
_______________________________________________________________________________________
Farm/Applicant Name:
________________________________________________________________________________________
Type of Tomato Farm: ___Field Grown ___Greenhouse Type of Tomatoes Grown:
______________________________________
Farm Address: See Page 2
Applicant/Leasee Address:
City/State/Zip:
_________________________________ ________ _____________
_,
,
_______________________
___________
__________________________
Phone Number: (
)
Ext:
Mobile Number: (
)
Fax Number:
(
)
________________________
Directions/GPS Coordinates: _
__________________________________________________________________________________
INFORMATION ABOUT THE OWNER/APPLICANT
Name of Owner/Applicant:
____________________________________________________________________________________
Business Type: ____ Corporation _____ Sole Proprietor ____ Partnership ____ Trust ____ Charitable ____ Other
If Other, Please list here:
______________________________________________________________________________________
Phone Number: (
)
_________________________
Ext:
_____________
Mobile Number: (
)
_________________________
Mailing Address:
____________________________________________________________________________________________
City/State/Zip:
_______________________________ __________ _____________
_,
E-mail:
________________________________________________________________
This application must be signed by the applicant, owner or chief executive of the applicant, without the need for witnesses. If a corporation
is in the hands of a receiver or trustee, this application shall be executed on behalf of the corporation by the receiver or trustee. I certify that
I am empowered to execute this application.
Org. Code:42070204000
Print Name of Applicant
EO A2
Object Code: 001037
$100.00
Title
Signature
Date
FDACS-07155 Rev. 10/13
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Division of Fruit and Vegetables
ANNUAL TOMATO FARM AND GREENHOUSE
REGISTRATION APPLICATION
NICOLE "NIKKI" FRIED
Make check or money order payable to
COMMISSIONER
FDACS and remit with application to:
Rule 5G-6.007, F.A.C.
Division of Fruit and Vegetables
Phone: (863) 578-1947 or 1927
Office of License and Bond
(800) 782-3240 Ext 1947 or 1927
170 Century Blvd,
Bartow, Florida, 33830-9701
Attn: Bonds and Licenses
The Department of Agriculture and Consumer Services is the exclusive regulatory and permitting authority for any person, business or
corporation engaged in the farming of fresh tomatoes. Farming is defined as the growing and harvesting of fresh tomatoes for movement to a
packing house or other packing/repacking facility where final preparation and packing will be completed before distribution. REMIT
PERMIT COST OF $100.00 WITH APPLICATION.
INFORMATION ABOUT THE LOCATION TO BE REGISTERED
____ Renewal
_____ New Business
____ Corrected Information
____ Other
If other, please list here:
_______________________________________________________________________________________
Farm/Applicant Name:
________________________________________________________________________________________
Type of Tomato Farm: ___Field Grown ___Greenhouse Type of Tomatoes Grown:
______________________________________
Farm Address: See Page 2
Applicant/Leasee Address:
City/State/Zip:
_________________________________ ________ _____________
_,
,
_______________________
___________
__________________________
Phone Number: (
)
Ext:
Mobile Number: (
)
Fax Number:
(
)
________________________
Directions/GPS Coordinates: _
__________________________________________________________________________________
INFORMATION ABOUT THE OWNER/APPLICANT
Name of Owner/Applicant:
____________________________________________________________________________________
Business Type: ____ Corporation _____ Sole Proprietor ____ Partnership ____ Trust ____ Charitable ____ Other
If Other, Please list here:
______________________________________________________________________________________
Phone Number: (
)
_________________________
Ext:
_____________
Mobile Number: (
)
_________________________
Mailing Address:
____________________________________________________________________________________________
City/State/Zip:
_______________________________ __________ _____________
_,
E-mail:
________________________________________________________________
This application must be signed by the applicant, owner or chief executive of the applicant, without the need for witnesses. If a corporation
is in the hands of a receiver or trustee, this application shall be executed on behalf of the corporation by the receiver or trustee. I certify that
I am empowered to execute this application.
Org. Code:42070204000
Print Name of Applicant
EO A2
Object Code: 001037
$100.00
Title
Signature
Date
FDACS-07155 Rev. 10/13
Page 1 of 2
1-Field Number_____
Physical Address_
___________________________________________________
GPS Coordinates or Legal Description_
__________________________________
Approximate Date of Harvest_
_______________
2-Field Number_____
Physical Address_
__________________________________________________
GPS Coordinates or Legal Description_
_________________________________
Approximate Date of Harvest_
_______________
3-Field Number_____
Physical Address_
__________________________________________________
GPS Coordinates or Legal Description_
_________________________________
Approximate Date of Harvest_
_______________
4-Field Number_____
Physical Address_
_________________________________________________
GPS Coordinates or Legal Description_
________________________________
Approximate Date of Harvest_
______________
FDACS-07155 Rev. 10/13
Page 2 of 2
Page of 2