Fillable Commonwealth of Massachusetts Application for Licensure for the Manufacture and Sale of Stuffed Toys, Bedding, Upholstered Furniture and Related Products

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Commonwealth of Massachusetts Application for Licensure for the Manufacture and Sale of Stuffed Toys, Bedding, Upholstered Furniture and Related Products

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The Commonwealth of Massachusetts Application for Licensure for the Manufacture and Sale of Stuffed Toys, Bedding, Upholstered Furniture and Related Products form is 2 pages long and contains:

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  • 4 check-boxes
  • 56 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Ch Check the boxes that apply: INITIAL APPLICATION RENEWAL
BEDDING/UPHOLSTERED FURNITURE STUFFED TOYS
INSTRUCTIONS:
• Complete the entire two-page application form.
Manufacturers must submit a separate application for each
manufacturing facility.
• Attach Law Label or “Mock Label” to the application.
• Attach a separate check for $300.00 for each license application,
made payable to: The Commonwealth of Massachusetts.
1. Company Name:
2. Telephone #: ( )
Ext. _______
Fax #: ( )
3. D.B.A.
Current Massachusetts License # MA-__________
(if applicable):
4. Mailing Address:
5. Facility Address (if different from Mailing Address):
6. Telephone #: ( )
Ext._______
Fax #: ( )
7. Responsible Contact Person:
8. 24 Hour Emergency Telephone #: ( ) Ext. ________
Email Address (mandatory): _______________________________________
9. Type of License for which you are applying:
Manufacturer
You are a manufacturer if you, either by
yourself or through your employees or
agent, manufacture articles of stuffed
toys, bedding and/or upholstered
furniture to be sold at wholesale or retail.
Uniform Registry Number :
__________________________________
State of Issuance:___________________
Distributor
You are a distributor or dealer if
you, either by yourself or
through your employees or
agent, sell articles of stuffed
toys, bedding and/or upholstered
furniture at wholesale or retail.
Supply Dealer
You are a supply dealer if you, either by
yourself or through your employees or
agent, manufacture, process, or sell any felt
batting, pads, or other filling, loose, in bags,
in bales or containers, concealed or not
concealed, to be used or which can be used
in articles of stuffed toys, bedding and
upholstered furniture.
The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Tel: (617) 983-6712 Fax: (617) 524-8062
In Accordance with M.G.L. C.94, 271 and/or 105 CMR 620.000
Return to: Food Protection Program, 305 South Street, Jamaica Plain, MA 02130
Application for Licensure for the Manufacture and Sale
of Stuffed Toys, Bedding, Upholstered Furniture, and Related Products
and/or 105 CMR 620.000
(Doing Business As):
Provide Check or
Money Order Number:
Address
A.
B.
A.
B.
A.
B.
C.
A.
B.
C.
13. If Applicant is a Corporation: A) State of Incorporation: B) Date of Incorporation:
14. List articles manufactured or sold:
I hereby certify that the above information is true to the best of my knowledge and that I will comply with all applicable
laws and regulations of the Commonwealth of Massachusetts and the Department of Public Health pertaining to the
activity for which I am applying. In addition, pursuant to M.G.L. C. 62C, § 49A, I certify under the penalties of perjury
that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law.
________________________ _________________________________________________________________
Date
If applying as an Individual, include your Social Security #:
Owner or Corporate Officer
Tax or Federal I.D.#: _________________________
IMPORTANT NOTE: Please allow 6 – 8 weeks for processing.
Your license is still valid one month after the expiration date.
NOTE: Copies of the Massachusetts General Laws and the Code of Massachusetts Regulations may be obtained from the
State House Bookstore located in Boston (617-727-2834), Fall River (508-646-1374) or Springfield (413-784-1376).
Revised 06/17
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_____________________________________
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Commonwealth of Massachusetts Application for Licensure for the Manufacture and Sale of Stuffed Toys, Bedding, Upholstered Furniture and Related Products

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Completed 19 May 2020

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