Fillable 72-244-271 SoftServeApplication2020 State of California

Fill Online, Printable, Fillable, Blank 72-244-271 SoftServeApplication2020 State of California Form

Use Fill to complete blank online CALIFORNIA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

72-244-271 SoftServeApplication2020 State of California

On average this form takes 13 minutes to complete

The 72-244-271 SoftServeApplication2020 State of California form is 1 page long and contains:

  • 2 signatures
  • 12 check-boxes
  • 38 other fields

Country of origin: US
File type: PDF

BROWSE CALIFORNIA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
D
□
D D
D
□
D
□ □
D D D
STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Milk and Dairy Food Safety Branch
1220 N Street
Sacramento, CA 95814
(916) 900-5008
APPLICATION FOR A SEMI-FROZEN (SOFT SERVE) MILK PRODUCTS PLANT LICENSE
Application is hereby made for a license to operate a Semi-frozen (Soft Serve) Milk Products Plant for the
calendar year ending December 31, 2020 in ________________________ County.
NAME OF BUSINESS ___________________________________________ PHONE # _________________
(Include restaurant/store number if applicable)
LOCATION OF BUSINESS ___________________________________________________________________
Number Street Unit # City Zip Code
MAILING ADDRESS ________________________________________________________________________
Number Street City State Zip Code
CHECK ONE: Individual Partnership LLC Corporation FED TAX ID # _____ - ____________
NAME OF OWNER(S) (PLEASE PRINT; if corporation, give name of President):
LAST NAME: _________________________________________ FIRST NAME: ________________________
Signature: _______________________________________________________ Date: ___________________
PRODUCTS PROCESSED/MANUFACTURED:
Ice Cream Frozen Yogurt Nondairy Frozen Dessert
DATE TO BEGIN OPERATING:
MO DAY YEAR
If you begin operating: First Year’s Prorated License Fee:
Any Time between January 1 and March 31
$ 333.00
Any Time between April 1 and June 30
$ 249.75
Any Time between July 1 and September 30
$ 166.50
Any Time between October 1 and December 31
$ 83.25
Please make the check payable to: CDFA 90102 L and mail this application with the appropriate fee to:
CASHIER, California Department of Food and Agriculture
P.O. Box 942872, Sacramento, CA 94271-2872
Please be sure all information is COMPLETE & LEGIBLE. A license cannot be issued if application is incomplete.
**************************************************FOR CDFA USEONLY************************************************
New Plant: Yes No PREVIOUS OWNER’S LAST OPERATING DATE:
TYPE:
Regular Seasonal Mobile, Serial VIN Number: Plate #
The equipment and sanitary conditions at this facility are satisfactory for issuance of a Soft Serve License.
RDI’s Signature: RDI# _________ Date: ________
Amount Received $ RC#
Form 72-244/271 (rev.9/19)
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

72-244-271 SoftServeApplication2020 State of California

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 1 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document