Form AG-00129 "Application for Specialty Fertilizer Product Registration" - Minnesota

What Is Form AG-00129?

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-00129 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-00129 "Application for Specialty Fertilizer 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 Specialty Fertilizer Product Registration
License Period of January 1 to December 31
Do you have a Special Fertilizer 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:
Contains Micro
Guaranteed Analysis
Complete Brand Name of Fertilizer
Nutrients
This column must
Item #
Total
Available
Soluble
Product registration WILL NOT be granted until product label/label
be completed or
Nitrogen
Phosphate
Potash
facsimile and material used in promoting the sale of each product is
application will not
(N)
(P205)
(K2O)
submitted with application.
be processed
1
YES
NO
2
YES
NO
3
YES
NO
4
YES
NO
5
YES
NO
6
YES
NO
7
YES
NO
8
YES
NO
9
YES
NO
10
YES
NO
11
YES
NO
12
YES
NO
APPLICATION FEES
Number of New Products ________ X $100.00 each = Total Amount Due $___________
600295(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. I also certify that fertilizer products distributed
in Minnesota by my company comply with Minnesota Statue 18C, and do not contain more than 500 parts per million by weight of arsenic.
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-00129
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 Specialty Fertilizer Product Registration
License Period of January 1 to December 31
Do you have a Special Fertilizer 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:
Contains Micro
Guaranteed Analysis
Complete Brand Name of Fertilizer
Nutrients
This column must
Item #
Total
Available
Soluble
Product registration WILL NOT be granted until product label/label
be completed or
Nitrogen
Phosphate
Potash
facsimile and material used in promoting the sale of each product is
application will not
(N)
(P205)
(K2O)
submitted with application.
be processed
1
YES
NO
2
YES
NO
3
YES
NO
4
YES
NO
5
YES
NO
6
YES
NO
7
YES
NO
8
YES
NO
9
YES
NO
10
YES
NO
11
YES
NO
12
YES
NO
APPLICATION FEES
Number of New Products ________ X $100.00 each = Total Amount Due $___________
600295(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. I also certify that fertilizer products distributed
in Minnesota by my company comply with Minnesota Statue 18C, and do not contain more than 500 parts per million by weight of arsenic.
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-00129
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