Form AG04015 "Registration for Selling Poultry and Rabbits in Minnesota" - Minnesota

What Is Form AG04015?

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 March 1, 2021;
  • 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 AG04015 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

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Download Form AG04015 "Registration for Selling Poultry and Rabbits in Minnesota" - Minnesota

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625 Robert Street North, Saint Paul, MN 55155-2538
www.mda.state.mn.us
651-201-6300
Dairy and Meat Inspection Division
REGISTRATION FOR SELLING POULTRY AND RABBITS IN MINNESOTA
Most small-scale producers wishing to sell slaughtered poultry or rabbits in Minnesota directly from the farm may do so without a food handler’s
license or inspections from the Minnesota Department of Agriculture (MDA). However, these producers must still follow state regulations for
handling, labeling, and storage to provide wholesome, safe products to consumers. The Minnesota Department of Agriculture (MDA) registers
producers selling poultry or rabbits directly to consumers in the state. Completing this registration form is voluntary and not required by law.
(Minnesota Statutes Chapter 28A.15
and
Minnesota Statutes Chapter 29
)
Privacy Notice: Please be aware that information submitted with this form is presumptively public under Minnesota law. The MDA is
required by law to provide public information in response to any data request made for that information.
Name of Applicant(s)
(Individuals from the same business may apply on the same registration form)
Mailing Address
City
State
Zip
Physical Address (if different from Mailing Address)
City
State
Zip
Business Phone
Email
Name of person(s) or business to be listed on certificate
(if different from Name of Applicants)
POULTRY
RABBITS
(Leave this section blank if you are not selling poultry)
(Leave this section blank if you are not selling rabbits)
Scale of Operation
Scale of Operation
Select one choice below to indicate
Select one choice below to indicate
the quantity of poultry you will sell each calendar year:
the quantity of rabbits you will sell each calendar year:
Selling up to 1,000 poultry per year
Selling up to 1,000 rabbits per year
Selling between 1,000 and 5,000 poultry per year
Selling between 1,000 and 5,000 rabbits per year
Selling between 5,000 and 20,000 poultry per year
Selling between 5,000 and 20,000 rabbits per year
How do you plan to harvest your birds?
Select one or
How do you plan to harvest your rabbits?
Select one or
both options below:
both options below:
I will slaughter the birds on my farm
I will slaughter the rabbits on my farm
I will bring my birds to be slaughtered at a USDA or
I will bring my rabbits to be slaughtered at a USDA or
Minnesota Equal To processing facility (birds slaughtered
Minnesota Equal To processing facility (rabbits slaughtered
at custom exempt processing facilities can only be for
at custom exempt processing facilities can only be for
personal household use and may NOT be sold or donated)
personal household use and may NOT be sold or donated)
ACKNOWLEDGMENT OF EXPECTATIONS
The seller agrees to the following (check each item to indicate you have read and agree to the statement):
I understand that this registration only applies to poultry/rabbits raised on my own farm and sold directly to the end consumer; I
may not collect and sell poultry/rabbits from multiple farms without obtaining a food handler’s license
I understand that the poultry/rabbits I sell must be slaughtered under sanitary conditions, either on my farm or at a USDA or
Minnesota Equal To processing facility
I understand that if I slaughter and process poultry/rabbits on my farm for sale, the facility where the poultry/rabbits are
slaughtered and processed must meet requirements as outlined in
9 CFR § 416.2-416.5
I understand that the poultry/rabbits I sell must be properly labeled: Farm-slaughtered poultry/rabbits must have my name, the
name and address of my farm, and the product name on the label, as well as “Exempt PL 90-492” for poultry
I am aware that the MDA has the authority to inspect my operation if deemed necessary
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG 04015
Page 1 of 2 3/2021
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
651-201-6300
Dairy and Meat Inspection Division
REGISTRATION FOR SELLING POULTRY AND RABBITS IN MINNESOTA
Most small-scale producers wishing to sell slaughtered poultry or rabbits in Minnesota directly from the farm may do so without a food handler’s
license or inspections from the Minnesota Department of Agriculture (MDA). However, these producers must still follow state regulations for
handling, labeling, and storage to provide wholesome, safe products to consumers. The Minnesota Department of Agriculture (MDA) registers
producers selling poultry or rabbits directly to consumers in the state. Completing this registration form is voluntary and not required by law.
(Minnesota Statutes Chapter 28A.15
and
Minnesota Statutes Chapter 29
)
Privacy Notice: Please be aware that information submitted with this form is presumptively public under Minnesota law. The MDA is
required by law to provide public information in response to any data request made for that information.
Name of Applicant(s)
(Individuals from the same business may apply on the same registration form)
Mailing Address
City
State
Zip
Physical Address (if different from Mailing Address)
City
State
Zip
Business Phone
Email
Name of person(s) or business to be listed on certificate
(if different from Name of Applicants)
POULTRY
RABBITS
(Leave this section blank if you are not selling poultry)
(Leave this section blank if you are not selling rabbits)
Scale of Operation
Scale of Operation
Select one choice below to indicate
Select one choice below to indicate
the quantity of poultry you will sell each calendar year:
the quantity of rabbits you will sell each calendar year:
Selling up to 1,000 poultry per year
Selling up to 1,000 rabbits per year
Selling between 1,000 and 5,000 poultry per year
Selling between 1,000 and 5,000 rabbits per year
Selling between 5,000 and 20,000 poultry per year
Selling between 5,000 and 20,000 rabbits per year
How do you plan to harvest your birds?
Select one or
How do you plan to harvest your rabbits?
Select one or
both options below:
both options below:
I will slaughter the birds on my farm
I will slaughter the rabbits on my farm
I will bring my birds to be slaughtered at a USDA or
I will bring my rabbits to be slaughtered at a USDA or
Minnesota Equal To processing facility (birds slaughtered
Minnesota Equal To processing facility (rabbits slaughtered
at custom exempt processing facilities can only be for
at custom exempt processing facilities can only be for
personal household use and may NOT be sold or donated)
personal household use and may NOT be sold or donated)
ACKNOWLEDGMENT OF EXPECTATIONS
The seller agrees to the following (check each item to indicate you have read and agree to the statement):
I understand that this registration only applies to poultry/rabbits raised on my own farm and sold directly to the end consumer; I
may not collect and sell poultry/rabbits from multiple farms without obtaining a food handler’s license
I understand that the poultry/rabbits I sell must be slaughtered under sanitary conditions, either on my farm or at a USDA or
Minnesota Equal To processing facility
I understand that if I slaughter and process poultry/rabbits on my farm for sale, the facility where the poultry/rabbits are
slaughtered and processed must meet requirements as outlined in
9 CFR § 416.2-416.5
I understand that the poultry/rabbits I sell must be properly labeled: Farm-slaughtered poultry/rabbits must have my name, the
name and address of my farm, and the product name on the label, as well as “Exempt PL 90-492” for poultry
I am aware that the MDA has the authority to inspect my operation if deemed necessary
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request
AG 04015
Page 1 of 2 3/2021
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
APPLICANT SIGNATURE AND DATE
(If more than one applicant: Select a primary applicant, such as the farm owner or head of household, to sign and date.)
Signature
Date
How would you like to receive your certificate of registration?
Select one option
Electronic copy, sent to the email address I provided on this form
Hard copy, mailed to the business address I provided on this form
Submit your registration form to the MDA Meat, Poultry, and Egg Inspection Program by email or mail. Please do not fax
MDA.MeatPoultryEgg@state.mn.us
completed forms. Email the completed form to
OR mail the form to:
Minnesota Department of Agriculture
Attention: Meat, Poultry, and Egg Inspection
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 04015
Page 2 of 2 3/2021
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
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