Form AG00960 "Application for Grain Buyer License" - Minnesota

What Is Form AG00960?

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 May 1, 2020;
  • 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 AG00960 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

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Download Form AG00960 "Application for Grain Buyer License" - Minnesota

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625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Plant Protection Division
Phone: 651-201-6011
Minnesota Statutes Chapters 223
APPLICATION FOR GRAIN BUYER LICENSE
ENTITY ID
20
Ap
plication for Buy and Store Grain License
The data on this form will be used to process your application. You must provide your Minnesota Tax ID number. If you do not have one, you must provide your social security
number (MS Sec 270C.72). We are required by law to collect this information and we cannot grant your license without it. No one will have access to your social security
number except those permitted access by law, your written consent, court order, or those department employees whose job duties require access. Pursuant to MS Sec
297A.66 if your company maintains within the state an office or place of distribution or sales person or other employee that solicits, sells or delivers goods or services in the
state you must have a Minnesota Tax ID number. If you are unsure if you need a Minnesota Tax ID, contact the Minnesota Department of Revenue at www.taxes.state.mn.us.
Legal Name
MN Tax ID or if none, Social Security
DBA (if different)
Mailing Address (if different)
Physical Street Address (No PO Box)
City
State
Zip
Company Phone
City
State
Zip
Workers’ Compensation. Do you have any paid or otherwise compensated employees in Minnesota?
Yes
or
No
If yes, complete the following:
Insurance Company Name
Effective Date
Policy Number
Expiration Date
You must provide acceptable evidence of compliance with the Workers’ Compensation Insurance Law (MS Sec 176.182). If you are self-insured, attach a copy of the exemption order from the
Commissioner of Commerce authorizing self-insurance. For questions, contact the Minnesota Department of Labor and Industry at www.doli.state.mn.us.
Do you purchase grain on contract? (deferred payment, priced later, etc.) Yes
or No
When is your Fiscal Year End: _____/_____/________
*See MS 223.177 for contract requirements.
This facility is a USDA licensed warehouse and will provide evidence of annual examination. Yes
or No
Licensed Locations
(Attach additional sheets if necessary)
Buyer Fee
Exam Fee
License Number
City/Zip
County
Capacity
(see below)
(see below)
Address
(office use only)
600506(3100)
600509(3200)
Total
$
Amount Due
Buyer Fee
Examination Fee
(Bushel Capacity)
Financial Requirements: All applicants will
Exam with no Measure
$100
Gross Annual Grain
First
Additional
be required to submit reviewed financial
Purchases (GAGP)
Location
Location
150,000 or less
$300
statements prepared by a certified public
150,001 to 250,000
$425
accountant at least once during the
Less than $100,000
$140
$110
250,001 to 500,000
$545
licensing period. Applicants purchasing
500,001 to 750,000
$700
$100,000 to $750,000
$275
$110
less than $100,000 in grain annually with
750,001 to 1,000,000
$865
$750,000 to $1,500,000
$415
$220
cash or cash equivalent are exempt.
1,000,001 to 1,200,000
$1,040
$1,500,000 to $3,000,000
$550
$220
1,200,001 to 1,500,000
$1,205
Security Requirements: First year
$3,000,000 or More
$700
$220
1,500,001 to 2,000,000
$1,380
applicants must secure a Grain Bond
2,000,001 or More
$1,555
or Irrevocable Letter of Credit (ILOC)
in the amount of $50,000. Applicants
I hereby certify that the information contained in and submitted with this form is true and correct.
purchasing less than$100,000 in grain
annually with cash or cash equivalent are
Signature
Date
exempt. Only one Grain Bond or ILOC is
Name (please print)
Title
required to cover all licensed locations.
Contact Phone
Fax
For Office Use Only
Email
Return this form with your check made payable to:
Minnesota Department of Agriculture
Attention Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG 00960
5/20
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Plant Protection Division
Phone: 651-201-6011
Minnesota Statutes Chapters 223
APPLICATION FOR GRAIN BUYER LICENSE
ENTITY ID
20
Ap
plication for Buy and Store Grain License
The data on this form will be used to process your application. You must provide your Minnesota Tax ID number. If you do not have one, you must provide your social security
number (MS Sec 270C.72). We are required by law to collect this information and we cannot grant your license without it. No one will have access to your social security
number except those permitted access by law, your written consent, court order, or those department employees whose job duties require access. Pursuant to MS Sec
297A.66 if your company maintains within the state an office or place of distribution or sales person or other employee that solicits, sells or delivers goods or services in the
state you must have a Minnesota Tax ID number. If you are unsure if you need a Minnesota Tax ID, contact the Minnesota Department of Revenue at www.taxes.state.mn.us.
Legal Name
MN Tax ID or if none, Social Security
DBA (if different)
Mailing Address (if different)
Physical Street Address (No PO Box)
City
State
Zip
Company Phone
City
State
Zip
Workers’ Compensation. Do you have any paid or otherwise compensated employees in Minnesota?
Yes
or
No
If yes, complete the following:
Insurance Company Name
Effective Date
Policy Number
Expiration Date
You must provide acceptable evidence of compliance with the Workers’ Compensation Insurance Law (MS Sec 176.182). If you are self-insured, attach a copy of the exemption order from the
Commissioner of Commerce authorizing self-insurance. For questions, contact the Minnesota Department of Labor and Industry at www.doli.state.mn.us.
Do you purchase grain on contract? (deferred payment, priced later, etc.) Yes
or No
When is your Fiscal Year End: _____/_____/________
*See MS 223.177 for contract requirements.
This facility is a USDA licensed warehouse and will provide evidence of annual examination. Yes
or No
Licensed Locations
(Attach additional sheets if necessary)
Buyer Fee
Exam Fee
License Number
City/Zip
County
Capacity
(see below)
(see below)
Address
(office use only)
600506(3100)
600509(3200)
Total
$
Amount Due
Buyer Fee
Examination Fee
(Bushel Capacity)
Financial Requirements: All applicants will
Exam with no Measure
$100
Gross Annual Grain
First
Additional
be required to submit reviewed financial
Purchases (GAGP)
Location
Location
150,000 or less
$300
statements prepared by a certified public
150,001 to 250,000
$425
accountant at least once during the
Less than $100,000
$140
$110
250,001 to 500,000
$545
licensing period. Applicants purchasing
500,001 to 750,000
$700
$100,000 to $750,000
$275
$110
less than $100,000 in grain annually with
750,001 to 1,000,000
$865
$750,000 to $1,500,000
$415
$220
cash or cash equivalent are exempt.
1,000,001 to 1,200,000
$1,040
$1,500,000 to $3,000,000
$550
$220
1,200,001 to 1,500,000
$1,205
Security Requirements: First year
$3,000,000 or More
$700
$220
1,500,001 to 2,000,000
$1,380
applicants must secure a Grain Bond
2,000,001 or More
$1,555
or Irrevocable Letter of Credit (ILOC)
in the amount of $50,000. Applicants
I hereby certify that the information contained in and submitted with this form is true and correct.
purchasing less than$100,000 in grain
annually with cash or cash equivalent are
Signature
Date
exempt. Only one Grain Bond or ILOC is
Name (please print)
Title
required to cover all licensed locations.
Contact Phone
Fax
For Office Use Only
Email
Return this form with your check made payable to:
Minnesota Department of Agriculture
Attention Cashier
625 Robert Street North
Saint Paul, MN 55155-2538
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG 00960
5/20
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.