State of California, DEPARTMENT OF FOOD AND AGRICULTURE NIPM Item # 2.1
Pest Exclusion/Nursery, Seed and Cotton Programs
64-029 (Rev. 1/11)
APPLICATION FOR
LICENSE TO SELL NURSERY STOCK
Please print or type information in spaces where indicated. Complete ALL sections.
FIRM NAME OR DBA & MAILING ADDRESS (AS IT WILL APPEAR ON YOUR LICENSE): SALES LOCATION (GIVE SPECIFIC ADDRESS, NOT P. O. BOX): COUNTY:
CONTACT
PERSON:
CITY: ZIP:
TELEPHONE:
TELEPHONE: FAX:
OWNER’S NAME(S) OR PARENT CORPORATION NAME:
E-MAIL ADDRESS:
# OF ACRES FOR THIS LOCATION
PART I CALCULATE YOUR FEES HERE
1. BASIC LICENSE FEE
1a. $
150.00
2. ACREAGE FEE: Required for land in excess of one
acre used in the production, sale or storage of nursery stock
(Include growing grounds acreage from reverse side in this
calculation)
List total # acres to assist in calculating the fee
0 1.0 acres . . . $ 0
1.01 - 5.0 acres . . . $ 100
5.01 - 20.0 acres . . . $ 250
20.01 - 50.0 acres . . . $ 400
50.01 - 200.0 acres . . . $ 600
200.01 - 500.0 acres . . . $ 800
500.01 - + acres . . . $ 900
-
LIST
TOTAL
# ACRES
=
2a
Please check this box if you
qualify for the acreage fee exemption AND
enter zero fees in box 2b below
ACREA
GE FEE EXEMPTION*:
If greater than 75% of
your nursery’s gross income comes from sales of cut
flowers/cut ornamentals, you do not need to pay the acreage
fee. Check box 2a and enter zero fees in box 2b. List total #
acres in box to right (examples: 0.25, 1.5, 12)
2b.
Calculate your acreage fees due and
enter amount here (Do not include
fractions of an acre in calculations.)
$
3. TOTAL FEES DUE (Add total of 1a and 2b and enter in 3a) 3a. TOTAL DUE $
SEND THIS APPLICATION ALONG WITH CHECK OR MONEY ORDER PAYABLE TO: “CDFA –90054” AND MAIL TO:
CASHIER
California Department of Food and Agriculture
1220 N Street
Sacramento, California 95814
NOTE: Allow six to eight weeks for license processing.
PART II TYPE OF B USINESS ( Check one or more and answer questions below. See reverse for business descriptions.)
Cut Flowers/Cut Ornamentals Jobber/Broker/Commission Merchant
Producer
Incidental Retailers Landscaper
Retailer
Do you have growing grounds? YES NO
If yes, please fill in Part IV on reverse side.
Do you intend to sell at Farmers’ Markets? YES NO
If yes, please fill in Part V on reverse side.
PART III TYPE OF NURSERY STOCK ( Check as many as applicable. Commercial producers must complete this section.)
1. Coniferous evergreens 7. Bulbs, corms, rhizomes, etc. D. Other subtropical & tropical
fruit trees, including avocado
2. Broad-leaved evergreens 8. Decorative plants, foliage or florist’s
potted plants, including orchids
E. Strawberry, bushberry, etc.
3. Deciduous shade trees 9. Cacti and succulents F. Vegetable plants
4. Deciduous shrubs A. Deciduous fruit & nut trees**
(see reverse) G. Sod (turfgrass)
5. Rose plants B. Grapevine and kiwi plants**(
see reverse) H. Ground covers
6. Herbaceous ornamental annuals and
perennials and aquatics
C. Citrus trees**
(see reverse)
J. Palms
I hereby certify that the information submitted in this application is true and correct to the best of my knowledge and belief.
SIGNATURE OF AUTHORIZED REPRESENTATIVE OFFICIAL TITLE DATE
Departmental Use Only
Lic. No. ______________
Temp. Lic. ______
______
Annual
Lic
New Renewal
Previous License#___________
Branch
Change of Ownership
Change of Address Only
Growing Ground Addition
Change of Name Only
click to sign
signature
click to edit
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