ARIZONA DEPARTMENT OF AGRICULTURE
PLANT SERVICES DIVISION
APPLICATION FOR GENERAL NURSERY STOCK INSPECTION CERTIFICATION (R3-4-301)
NOTE: Submit application by February 15, 2019 for Certification Year 2020
Applicant Name and Position Title (Print) Nursery Name Tax Identification Numbe
Mailing Address Mailing City, State, and Zip Code Mailing County
E-Mail Telephone FAX
Provide the physical addresses (street address, city, and zip code) and acreages for locations you would like to
have certified:
Acreage Department Use
1. ______________________________________________________________ _____ ______________
2. ______________________________________________________________ _____ _____________
3. ______________________________________________________________ _____ ______________
4. ______________________________________________________________ _____ ______________
5. ______________________________________________________________ _____ ______________
6. ______________________________________________________________ _____ ______________
7. ______________________________________________________________ _____ ______________
8. ______________________________________________________________ _____ ______________
9. ______________________________________________________________ _____ ______________
10. _____________________________________________________________ _____ ______________
What types of plants are grown at your nursery location(s)?
For Department Use
Annuals Aquatic Cactus Deciduous Total acreage from this application: _________________
Evergreen Fruit Indoor Foliage Palms Total locations on this application x $250 = __________
Perennials Turf Check box when inspections complete
Check box if you are a first time applicant:
____ ____________________________________________
_____________________________________
Authorized Signature Date
ADA PSD 0063G 12/14/18 jl https://agriculture.az.gov
ARIZONA DEPARTMENT OF AGRICULTURE - PLANT SERVICES DIVISION - 1688 W. ADAMS ST. - PHOENIX, AZ 85007 - (602) 542-0994
Completed applications must be submitted to: Arizona Department of Agriculture - Plant Services Division -
1688 W. Adams St. - Phoenix, AZ 85007. Payment for certification will be invoiced no earlier than November, 2019. The
Department certifies based on the National Plant Board standards for pest cleanliness. Applicant is responsible for fees
invoiced. Applications received after February 15th are NOT guaranteed certification for the following calendar year. The
Nursery Certification Program is authorized under Title 3, Chapter 4, Article 4 of the Arizona Administrative Code.
For questions, please call 602-542-0992.
