Fillable Application For Egg Marketing License Form printable pdf download

Application For Egg Marketing License Form

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No. ___________________

Mississippi Department of Agriculture and Commerce

P.O. Box 1609

Jackson, Mississippi 39215-1609

601-359-1102

APPLICATION FOR EGG MARKETING LICENSE

The undersigned hereby applies for license required by Section 69-7-267, Mississippi Code of 1972, as

amended, to engage in the business of producing and/or marketing eggs, as defined in Section 69-7-251(c)

Code of 1972, in the State of Mississippi.

Business Name

Contact Person

Physical Address (No PO Boxes)

City

State

Zip Code

County

Telephone

Fax

Mailing Address

City

State

Zip Code

State Business or Trade Name Used, if any

How long has applicant been engaged in business for which application is made?

Approximately number of cases of egg sold in Mississippi by applicant per month?

Approximately number of cases purchased by applicant for sale in Mississippi each month?

The undersigned applicant certifies that all supplementary statements and schedules attached hereto and

hereby made a part of this application and that all statements made in this application are true and correct,

and further agrees to abide by the terms and conditions of the Egg Marketing Law and the rules and

regulations promulgated under such law.

This the ________________ day of _____________________________, 19 _______________.

Enclose with this application:

License Fee of $50.00

Signature of Applicant

----------------------Do Not Write Below This Line - Office Use Only-----------------

(Date Received)

Check Number: ____________________

Amount Received: __________________

Application For Egg Marketing License Form

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