Form AG-00890 "Application for Soil/Plant Amendment Product Registration" - Minnesota

What Is Form AG-00890?

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

Form Details:

  • Released on November 6, 2019;
  • The latest edition provided by the Minnesota Department of Agriculture;
  • 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 AG-00890 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

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Download Form AG-00890 "Application for Soil/Plant Amendment Product Registration" - Minnesota

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625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Pesticide & Fertilizer Management Division
Phone: 651-201-6379 carol.durden@state.mn.us Minn. Stat. Sec. 18C.411
20
Application for Soil/Plant Amendment Product Registration
License Period of January 1 to December 31
Do you have a Soil/Plant Amendment Registration license in Minnesota?
YES
NO
If Yes, License No:
GUARANTOR (name/address on label, firm guaranteeing Products(s))
REGISTRANT (complete if different from Guarantor)
Company Legal Name:
Legal Name:
DBA (if different):
DBA (if different):
Address (address on label):
Mailing Address:
City:
State:
Zip Code:
City:
State:
Zip Code:
Company Telephone:
Company Telephone:
Complete Brand Name of Soil and Plant Amendment
Item #
Product registration will not be granted until product label/label facsimile and material
used in promoting the sale of each product is submitted with application.
1
2
3
4
5
6
7
8
9
10
11
12
APPLICATION FEES
Number of New Products ________ X $200.00 each = Total Amount Due $___________
600296(3100)
RETURN THIS FORM WITH YOUR CHECK MADE PAYABLE TO
FOR OFFICE USE ONLY
Minnesota Department of Agriculture
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Registrations are not transferable and fees are not refundable.
I hereby certify that the information contained in and submitted with this form is true and correct.
Signature:
Name (Please Print):
Date:
Title:
Phone:
Email:
Fax:
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG-00890
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
11/6/19
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Pesticide & Fertilizer Management Division
Phone: 651-201-6379 carol.durden@state.mn.us Minn. Stat. Sec. 18C.411
20
Application for Soil/Plant Amendment Product Registration
License Period of January 1 to December 31
Do you have a Soil/Plant Amendment Registration license in Minnesota?
YES
NO
If Yes, License No:
GUARANTOR (name/address on label, firm guaranteeing Products(s))
REGISTRANT (complete if different from Guarantor)
Company Legal Name:
Legal Name:
DBA (if different):
DBA (if different):
Address (address on label):
Mailing Address:
City:
State:
Zip Code:
City:
State:
Zip Code:
Company Telephone:
Company Telephone:
Complete Brand Name of Soil and Plant Amendment
Item #
Product registration will not be granted until product label/label facsimile and material
used in promoting the sale of each product is submitted with application.
1
2
3
4
5
6
7
8
9
10
11
12
APPLICATION FEES
Number of New Products ________ X $200.00 each = Total Amount Due $___________
600296(3100)
RETURN THIS FORM WITH YOUR CHECK MADE PAYABLE TO
FOR OFFICE USE ONLY
Minnesota Department of Agriculture
Attn: Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
Registrations are not transferable and fees are not refundable.
I hereby certify that the information contained in and submitted with this form is true and correct.
Signature:
Name (Please Print):
Date:
Title:
Phone:
Email:
Fax:
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG-00890
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
11/6/19