COTTAGE FOOD LICENSE APPLICATION
Gary W. Black
GEORGIA DEPARTMENT OF AGRICULTURE FOOD SAFETY DIVISION
COMMISSIONER
19 MARTIN LUTHER KING JR DRIVE SW ATLANTA, GA 30334
ESTABLISHMENT INFORMATION
NAME (Doing Business As)
CORPORATE NAME (If registered with the Secretary of State’s Office)
COUNTY OF RESIDENCE
STREET ADDRESS
STATE
ZIP
GA
MAILING ADDRESS (If Different)
STATE
ZIP
GA
OWNER INFORMATION
NAME
TITLE
PHONE
EMAIL ADDRESS
TYPE OF OWNERSHIP
(Individual, Corporation, Partnership, Association, etc.)
ATTACH A LIST OF OWNERS AND OFFICERS comprising the legal
ownership, including any Registered Agents, with the
following information:
Names / Titles / Addresses / Phone Numbers
PREREQUISITES
Indicate your ACKNOWLEDGEMENT and COMPLETION of these requirements by checking the following:
I have checked with my city and county governments, and there are no local ordinances that would
prevent me from operating a home-based business.
I have checked with my local public utilities to ensure that my cottage food operations meet their
approval for the existing sewage system, or I have checked with the local health department to ensure
my septic system is adequate for my intended operations.
I have attached either a copy of my most recent water bill, or the lab results where I had my private
well tested for coliforms and nitrates.
I have completed an accredited food safety training course, and a copy of my certificate is attached to
this License Application.
COTTAGE FOOD OPERATOR RESPONSIBILITIES
Please initial by each statement acknowledging the OPERATORS RESPONSIBILITIES.
I have read and understand the Food Safety Directives contained in the Cottage Food
Regulations 40-7-19-.08.
INITIALS
I understand that I can only make the Cottage Food Products listed on this application
form, and that the sales of these products can only be to the end consumer.
INITIALS
I understand that I can only sell these products within the state of Georgia, and that I cannot
ship my products across state lines without having first obtained a Food Sales
Establishment License from the Georgia Department of Agriculture and registering with
the FDA according to the Bioterrorism Act.
INITIALS
I understand that if I sell my products by weight that I have to use a scale that is legal for
trade, and that the Georgia Department of Agriculture will inspect my scale for accuracy
in response to consumer complaints of package tare errors or short-fill.
INITIALS
COTTAGE FOOD PRODUCTS LIST
Indicate each TYPE OF PRODUCT you intend to produce:
Breads, Rolls & Biscuits
Cakes & Cupcakes
Candies & Confections
Cereals, Trail Mixes & Granola
Coated / Uncoated Nuts
Dried Fruits
Dry Herbs, Seasonings & Mixtures
Fruit Pies
Jams, Jellies & Preserves
Pastries & Cookies
Popcorn, Popcorn Balls & Cotton Candy
Vinegars & Flavored Vinegars
**PLEASE DO NOT SUBMIT PAYMENT
WITH YOUR APPLICATION**
You will receive an email link to pay your license fee approximately
two (2) weeks following your licensing inspection.
Questions? Please see our website at:
http://www.agr.georgia.gov/cottage-foods.aspx
Contact us via phone:
Food Safety Division: 404-656-3627, or
Licensing Division: 404-586-1411
APPLICANT PRINTED NAME
APPLICANT SIGNATURE
APPLICANT TITLE
DATE
WATER
SOURCE:
DISPOSAL:
Public (Municipal)
Public (Sewer)
Private (Well)
Private (Septic System)
RIGHT OF ENTRY
Pursuant to O.C.G.A. § 26-2-36(a), the Georgia
Department of Agriculture is authorized to have free
access during all hours of operation and at all other
reasonable hours to any establishment where food is
manufactured, processed, packed or held for introduction
into commerce.
By completing this application, I understand the foregoing
and hereby grant the Department right of entry to the
residence, during the normal business hours, or at other
reasonable times, for the investigation of consumer
complaints, foodborne disease outbreaks, or other public
health emergencies.
I understand that inspections due to consumer complaints
or foodborne illnesses investigations are required to be
conducted within one hour upon receiving notice of the
intent to conduct an investigation. I further understand that
refusing entry of a Department representative, and any
additional investigators with appropriate credentials who
may accompany the Department for the purposes of
investigating consumer complaints or foodborne illnesses,
shall be grounds for revocation of my Cottage Food
License.
VERIFICATION OF LAWFUL PRESENCE
A Notarized Affidavit and acceptable documentation are
required by O.C.G.A. § 50-36-1.
Please notify us if you have previously submitted an
affidavit and one acceptable document for any other
license or GATE card issues by the Department.
This will allow us to search our databases and upload
the required documentation for your new license and
enable a better customer service experience.
For assistance, call the Customer Service Center at:
855-4-AG-LICENSE (855-424-5423)
ATTESTATIONS
By signing this document, the applicant:
1. Attests that the information provided on this form is
accurate; and
2. Affirms he/she will comply with Department laws and
regulations related to the operation of a cottage food
establishment.
SUBMIT VIA EMAIL
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