Form AG-01368 "Pet and/or Specialty Pet Food Product Registration for Products Distributed in Minnesota" - Minnesota

What Is Form AG-01368?

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 June 4, 2018;
  • 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-01368 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-01368 "Pet and/or Specialty Pet Food Product Registration for Products Distributed in Minnesota" - Minnesota

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625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Food and Feed Safety Division, Phone: 651-201-6027, Fax: 651-201-6119
MINN. STAT. SEC. 25.31-43
Pet and/or Specialty Pet Food Registration for Products Distributed in Minnesota
July 1, 20
Through June 30, 20
Note: A Minnesota Commercial Feed License is required for any person registering pet or specialty pet food products.
Minnesota Commercial Feed License #:
License Holder/Guarantor Legal Name:
Mailing Address Name (If Different):
DBA (Doing Business As):
Address:
Physical Address (No PO Box):
City, State, Zip:
City, State, Zip:
This form is for Pet and Specialty Pet Food Products sold EXCLUSIVELY in packages of 10 LBS OR LESS.
“Pet” means a domesticated dog or cat normally maintained in or near the household of its owner.
“Specialty pet” means any animal normally maintained in a household, such as, but not limited to, rodents, ornamental birds, ornamental
fish, reptiles and amphibians, ferrets, hedgehogs, marsupials, and rabbits not raised for food or fur. “Specialty pet” does not include a dog,
cat, horse, wild bird, livestock or poultry.
Please verify/include the following information to help process your application/labels:
y The guarantor, city, and state listed on your labels must match the license holder, city, and state on your license.
y A complete list of product names.
y Complete, current, and LEGIBLE product labels.
For specific questions about product registration, please contact us at 651-201-6027 or see our website at www.mda.state.mn.us/feed.
For questions about labeling requirements, please leave a message at 651-201-6221 or email MDA.FFSDPetFood.MDA@state.mn.us.
REGISTRATION FEE
Product Registration Fee
Number of Products
Amount
Amount Due
Code
Pet Food and Specialty Pet Food
x $100.00
$
600280/3200
Penalty Fee*
x $100.00
$
600280/3520
Total Due
$
Return this form with your check made payable to:
Minnesota Department of Agriculture
*PENALTY FEE (per product and in addition to the Registration
Attn: Cashier
Fee). Applies if an unregistered product is distributed in
625 Robert Street North
Minnesota prior to being licensed.
Saint Paul, MN 55155-2538
Licenses 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.
For Office Use Only
Signature:
Date:
Name (Please Print):
Title:
Contact Telephone:
Fax #:
Email Address:
AG-01368
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by
calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
6/4/18
Page 1 of 2
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Food and Feed Safety Division, Phone: 651-201-6027, Fax: 651-201-6119
MINN. STAT. SEC. 25.31-43
Pet and/or Specialty Pet Food Registration for Products Distributed in Minnesota
July 1, 20
Through June 30, 20
Note: A Minnesota Commercial Feed License is required for any person registering pet or specialty pet food products.
Minnesota Commercial Feed License #:
License Holder/Guarantor Legal Name:
Mailing Address Name (If Different):
DBA (Doing Business As):
Address:
Physical Address (No PO Box):
City, State, Zip:
City, State, Zip:
This form is for Pet and Specialty Pet Food Products sold EXCLUSIVELY in packages of 10 LBS OR LESS.
“Pet” means a domesticated dog or cat normally maintained in or near the household of its owner.
“Specialty pet” means any animal normally maintained in a household, such as, but not limited to, rodents, ornamental birds, ornamental
fish, reptiles and amphibians, ferrets, hedgehogs, marsupials, and rabbits not raised for food or fur. “Specialty pet” does not include a dog,
cat, horse, wild bird, livestock or poultry.
Please verify/include the following information to help process your application/labels:
y The guarantor, city, and state listed on your labels must match the license holder, city, and state on your license.
y A complete list of product names.
y Complete, current, and LEGIBLE product labels.
For specific questions about product registration, please contact us at 651-201-6027 or see our website at www.mda.state.mn.us/feed.
For questions about labeling requirements, please leave a message at 651-201-6221 or email MDA.FFSDPetFood.MDA@state.mn.us.
REGISTRATION FEE
Product Registration Fee
Number of Products
Amount
Amount Due
Code
Pet Food and Specialty Pet Food
x $100.00
$
600280/3200
Penalty Fee*
x $100.00
$
600280/3520
Total Due
$
Return this form with your check made payable to:
Minnesota Department of Agriculture
*PENALTY FEE (per product and in addition to the Registration
Attn: Cashier
Fee). Applies if an unregistered product is distributed in
625 Robert Street North
Minnesota prior to being licensed.
Saint Paul, MN 55155-2538
Licenses 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.
For Office Use Only
Signature:
Date:
Name (Please Print):
Title:
Contact Telephone:
Fax #:
Email Address:
AG-01368
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by
calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
6/4/18
Page 1 of 2
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Food and Feed Safety Division, Phone: 651-201-6027, Fax: 651-201-6119
MINN. STAT. SEC. 25.31-43
New Pet and/or Specialty Pet Food Registration for Products Distributed in
Minnesota July 1, 20
Through June 30, 20
Instructions
Brand and Product Name: Be as specific as possible including flavors, species, etc.
Additional Products:
If additional products are required to be registered, please list the required information on your company’s
letterhead paper and submit with this form.
Complete Brand and Product Name (See Instructions)
Item No.
Product Name
Sizes
AG-01368
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by
calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
6/4/18
Page 2 of 2
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