Form AG-01348 "New Commercial Animal Waste Technician Site Manager License Application" - Minnesota

What Is Form AG-01348?

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 September 1, 2017;
  • 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 printable version of Form AG-01348 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-01348 "New Commercial Animal Waste Technician Site Manager License Application" - Minnesota

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Pesticide & Fertilizer Management Division Ph. 651-201-6615 Fax 651-201-6105
New License Number:
Minn Stat. Sec. 18C.430
20___ NEW COMMERCIAL ANIMAL WASTE TECHNICIAN SITE MANAGER LICENSE APPLICATION
The data on this form will be used to process your application. 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.
Site Manager Information
(Please print)
Last Name:
First Name:
MI:
Social Security Number:
Company Information
Commercial Animal Waste Technician Site Manager License requires that you are employed by a licensed CAWT Company.
Company Legal Name:
DBA (if different):
Company Street Address (No PO Box):
Company Mailing Address (if different):
City:
Zip Code:
State:
City:
State:
Zip Code:
County:
Company Telephone:
Commercial Animal Waste Technician Company License Number (if available)
Financial Responsibility
(Check all that apply):
Proof of Financial Responsibility is required by the MN Fertilizer, Soil & Plant Amendment Law (Minn. Stat. Ch. 18C).
Liability Insurance
Net Asset Statement
Performance or Surety Bond
License Categories
(Check all that apply):
Liquid
Solid
Application Fees
600301(3102)
Application Fee:
$50.00
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
ATTN: Cashier
625 Robert Street North
Total Due:
$50.00
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 Number: _______________________
E-mail Address: ______________________________________________________________
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.
AG-01348 (09/17)
Date Computer Updated:__________________________
Pesticide & Fertilizer Management Division Ph. 651-201-6615 Fax 651-201-6105
New License Number:
Minn Stat. Sec. 18C.430
20___ NEW COMMERCIAL ANIMAL WASTE TECHNICIAN SITE MANAGER LICENSE APPLICATION
The data on this form will be used to process your application. 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.
Site Manager Information
(Please print)
Last Name:
First Name:
MI:
Social Security Number:
Company Information
Commercial Animal Waste Technician Site Manager License requires that you are employed by a licensed CAWT Company.
Company Legal Name:
DBA (if different):
Company Street Address (No PO Box):
Company Mailing Address (if different):
City:
Zip Code:
State:
City:
State:
Zip Code:
County:
Company Telephone:
Commercial Animal Waste Technician Company License Number (if available)
Financial Responsibility
(Check all that apply):
Proof of Financial Responsibility is required by the MN Fertilizer, Soil & Plant Amendment Law (Minn. Stat. Ch. 18C).
Liability Insurance
Net Asset Statement
Performance or Surety Bond
License Categories
(Check all that apply):
Liquid
Solid
Application Fees
600301(3102)
Application Fee:
$50.00
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
ATTN: Cashier
625 Robert Street North
Total Due:
$50.00
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 Number: _______________________
E-mail Address: ______________________________________________________________
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.
AG-01348 (09/17)
Date Computer Updated:__________________________