Fillable APPLICATION FOR A COMMERCIAL FEED LICENSE (Pennsylvania)

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APPLICATION FOR A COMMERCIAL FEED LICENSE (Pennsylvania)

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  • 37 check-boxes
  • 20 other fields

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File type: PDF

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API-225 (Rev. 6-2020)
APPLICATION FOR A COMMERCIAL FEED LICENSE
$25.00 FEE PER COMMERCIAL FEED LICENSE
If Different than the Business Name above, Commercial Feed is manufactured at the following locations(s):
Check the box under the following to indicate your type of business, or your planned business activities (check all that apply)
Type of Operation
Type of Processing
Type of Feed
Daily Volume
Distribution
Animal Feed Manufacturer
Rendering
Single Species
Less than 25 tons
Less Than 25 Miles
Animal Feed Guarantor
Pelleting
Mixed Species
25 – 100 tons
25 – 100 Miles
Pet Food Manufacturer
Extrusion
Feed Ingredient
101 – 300 tons
101 – 300 Miles
Pet Food Guarantor
Roasting
Medicated Feed
Over 300 tons
Nationwide
Steam Flaking
Non-Medicated Feed
International
Thermal Processing
Customer Formula Feed
Heating
Raw Pet Food
Refrigeration/Freezing
Pet Food (not raw)
Mixing
Feed Containing Ruminant Proteins
Milling
Vegetable Source Protein
Salvaging
Recovered Food
I verify that the above statements are true and correct to the best of my knowledge, information, and belief. I understand that false
statements are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities and may
result in criminal prosecution and suspension or revocation of my license.
I
hereby agree to comply with the provisions of the Pennsylvania Commercial Feed Act and Rules promulgated thereunder.
___________________________________ _______________________________________ _______________________
Signature Title Date
Return this application, with a check or money order in the amount of $25.00, payable to “Commonwealth of Pennsylvania”, to:
Pennsylvania Department of Agriculture, Bureau of Plant Industry, Feed Program, 2301 N Cameron Street, Harrisburg, PA 17110
The above company is licensed to distribute Commercial Feed in Pennsylvania for the period ending December 31, 20______.
____________________ ____________________ ____________________ ____________________
(P
aPlants ID) (Date Approved) Control Number) (Program Specialist)
Business Name
Physical Address Mailing Address
City City
State Zip
State
Zip
County Email
Phone # Fax #
Contact Name Job Title
Company Website
For Mobile Mills, list make, model and year of truck and license plate number:
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signature
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INSTRUCTIONS FOR COMPLETING THE COMMERCIAL FEED APPLICATION
Only Complete One Application Per Location
1. Enter the business information in the top box. For product guarantors, the business name and
address listed must match the business name and address on the product labels. For mobile mixers,
enter the information in the designated section.
2. If products are manufactured at a different location other than the business name, list the name and
address of the manufacturing facility. NOTE: If the manufacturing location is in Pennsylvania, that
location must also have a Commercial Feed License as a manufacturer. If the manufacturing location
does not have a Commercial Feed License, a separate license application must be completed.
3. Check the boxes to describe your business or what your business plans are within the next year.
4. Submit a check or money order in the amount of $25.00, made payable to Commonwealth of
Pennsylvania.
5. Send the completed application and fees to:
PA DEPARTMENT OF AGRICULTURE
BUREAU OF PLANT INDUSTRY
COMMERCIAL FEED
2301 N CAMERON STREET
HARRISBURG, PA 17110
For more information, visit our website at www.agriculture.pa.gov/Protect/PlantIndustry, or call the
Bureau of Plant Industry at (717) 787-4843.
You can apply for and receive a license much quicker by completing an online application and paying
with a credit card. To submit an online application, go to www.paplants.pa.gov and click “Apply for
New License”, then select “Feed Manufactures”. Enter the required information. All online
applications must be paid using a Visa, Mastercard, Discover, JCB or Diners Club International.
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APPLICATION FOR A COMMERCIAL FEED LICENSE (Pennsylvania)

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Completed 9 March 2021

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