Form AG-02468 "Application for Duplicate Applicator License/Certification" - Minnesota

What Is Form AG-02468?

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 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-02468 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download Form AG-02468 "Application for Duplicate Applicator License/Certification" - Minnesota

Download PDF

Fill PDF online

Rate (4.3 / 5) 14 votes
Pesticide & Fertilizer Management Division Ph. 651-201-6615 Fax 651-201-6105
Current Lic/Cert Number:
APPLICATION FOR DUPLICATE APPLICATOR LICENSE/CERTIFICATION
This application may only be used for current license holders and may not be used in place of a New License/Certification or Renewal Application.
License Holder:
Type
(Check only one):
Commercial Pesticide Applicator
Private Pesticide Applicator
Noncommercial Pesticide Applicator
Commercial Animal Waste Technician - Applicator
Noncommerical Pesticide Applicator (Government)
Commercial Animal Waste Technician - Site Manager
Reason for Duplicate License/Certification
Lost or Misplaced License/Certification
Adding Category
(please select from categories below)
Other (please explain)___________________________________________________________________________
A - Core
I - Anti-Microbial
O - Soil Fumigation
B - General Aerial
J - Nat Areas, Frstry, Rghts Of Wy
P - Vertebrate Pest Control
C - Field Crops Pest Management
K - Ag Pest Control - Animal
Q - Wood Preservatives
E - Turf and Ornamentals
L - Mosquito Control
R - Sewer Root Control
F - Aquatic
M - Food Processing Pest Management
S - Noncommercial Structural
(Noncommercial Only)
(Noncommercial Only)
H - Seed Treatment
Liquid
N - Stored Grain & Fumigation
Solid
Application/Certification Fees
(Check only one):
Commercial Pesticide Applicator (M.S. 18B.33)
$10.00
600306(3110)
Noncommercial Pesticide Applicator (M.S. 18B.34)
$10.00
600310(3110)
Noncommercial Government Pesticide Applicator (M.S. 18B.34)
$10.00
600314(3110)
Private Pesticide Applicator (M.S. 18B.36)
$5.00
600315(3110)
Commerical Animal Waste Technician - Applicator (M.S. 18C.430)
$10.00
600301(3111)
$10.00
600301(3112)
Commerical Animal Waste Technician - Site Manager (M.S. 18C.430)
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
ATTN: Cashier
625 Robert Street North
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-02468 (11/17)
Date Computer Updated:__________________________
Pesticide & Fertilizer Management Division Ph. 651-201-6615 Fax 651-201-6105
Current Lic/Cert Number:
APPLICATION FOR DUPLICATE APPLICATOR LICENSE/CERTIFICATION
This application may only be used for current license holders and may not be used in place of a New License/Certification or Renewal Application.
License Holder:
Type
(Check only one):
Commercial Pesticide Applicator
Private Pesticide Applicator
Noncommercial Pesticide Applicator
Commercial Animal Waste Technician - Applicator
Noncommerical Pesticide Applicator (Government)
Commercial Animal Waste Technician - Site Manager
Reason for Duplicate License/Certification
Lost or Misplaced License/Certification
Adding Category
(please select from categories below)
Other (please explain)___________________________________________________________________________
A - Core
I - Anti-Microbial
O - Soil Fumigation
B - General Aerial
J - Nat Areas, Frstry, Rghts Of Wy
P - Vertebrate Pest Control
C - Field Crops Pest Management
K - Ag Pest Control - Animal
Q - Wood Preservatives
E - Turf and Ornamentals
L - Mosquito Control
R - Sewer Root Control
F - Aquatic
M - Food Processing Pest Management
S - Noncommercial Structural
(Noncommercial Only)
(Noncommercial Only)
H - Seed Treatment
Liquid
N - Stored Grain & Fumigation
Solid
Application/Certification Fees
(Check only one):
Commercial Pesticide Applicator (M.S. 18B.33)
$10.00
600306(3110)
Noncommercial Pesticide Applicator (M.S. 18B.34)
$10.00
600310(3110)
Noncommercial Government Pesticide Applicator (M.S. 18B.34)
$10.00
600314(3110)
Private Pesticide Applicator (M.S. 18B.36)
$5.00
600315(3110)
Commerical Animal Waste Technician - Applicator (M.S. 18C.430)
$10.00
600301(3111)
$10.00
600301(3112)
Commerical Animal Waste Technician - Site Manager (M.S. 18C.430)
Return this form with your check made payable to:
MINNESOTA DEPARTMENT OF AGRICULTURE
ATTN: Cashier
625 Robert Street North
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-02468 (11/17)
Date Computer Updated:__________________________