Form AG04016 "Registration for Selling Shell Eggs in Minnesota" - Minnesota

What Is Form AG04016?

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 February 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 AG04016 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download Form AG04016 "Registration for Selling Shell Eggs in Minnesota" - Minnesota

Download PDF

Fill PDF online

Rate (4.6 / 5) 7 votes
625 Robert Street North, Saint Paul, MN 55155-2538
www.mda.state.mn.us
Dairy and Meat Inspection Division 651-201-6300
REGISTRATION FOR SELLING SHELL EGGS IN MINNESOTA
The Egg Products Inspection Act
(7 CFR §
57) exempts shell egg producers with fewer than 3,000 laying fowl from the USDA Shell Egg Surveillance
Program. The Minnesota Department of Agriculture (MDA) registers producers with fewer than 3,000 laying fowl who sell shell eggs to consumers
away from their premises (e.g., at farmers’ markets) or to food facilities in Minnesota. These producers do not need a food handler’s license to sell eggs
produced on their farm but must still follow state regulations for handling, labeling, and storage to provide wholesome, safe products to consumers.
Completing this registration form is voluntary and not required by law.
(Minnesota Statutes Chapter 29
and
Minnesota Rules Chapter
1520)
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)
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 eggs produced on my own farm from my own flock of layers; I may not
collect and sell eggs from multiple farms without obtaining a food handler’s license
I have reviewed and agree to conform to
regarding the candling,
Minnesota Statutes Chapter 29
and
Minnesota Rules Chapter 1520
grading, labeling, and handling of shell eggs
I have read the MDA guidance document “Safely Selling or Buying Locally Produced Eggs” available at
www.mda.state.mn.us/food-feed/sale-eggs-minnesota
(To request a printed copy, contact the Dairy and Meat Inspection Division)
I am aware that the MDA has the authority to inspect my operation if deemed necessary
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 completed forms.
Email the completed form to
MDA.MeatPoultryEgg@state.mn.us
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 04016
2/2021
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
Dairy and Meat Inspection Division 651-201-6300
REGISTRATION FOR SELLING SHELL EGGS IN MINNESOTA
The Egg Products Inspection Act
(7 CFR §
57) exempts shell egg producers with fewer than 3,000 laying fowl from the USDA Shell Egg Surveillance
Program. The Minnesota Department of Agriculture (MDA) registers producers with fewer than 3,000 laying fowl who sell shell eggs to consumers
away from their premises (e.g., at farmers’ markets) or to food facilities in Minnesota. These producers do not need a food handler’s license to sell eggs
produced on their farm but must still follow state regulations for handling, labeling, and storage to provide wholesome, safe products to consumers.
Completing this registration form is voluntary and not required by law.
(Minnesota Statutes Chapter 29
and
Minnesota Rules Chapter
1520)
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)
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 eggs produced on my own farm from my own flock of layers; I may not
collect and sell eggs from multiple farms without obtaining a food handler’s license
I have reviewed and agree to conform to
regarding the candling,
Minnesota Statutes Chapter 29
and
Minnesota Rules Chapter 1520
grading, labeling, and handling of shell eggs
I have read the MDA guidance document “Safely Selling or Buying Locally Produced Eggs” available at
www.mda.state.mn.us/food-feed/sale-eggs-minnesota
(To request a printed copy, contact the Dairy and Meat Inspection Division)
I am aware that the MDA has the authority to inspect my operation if deemed necessary
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 completed forms.
Email the completed form to
MDA.MeatPoultryEgg@state.mn.us
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 04016
2/2021
by calling 651-201-6000. TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.