Fillable HOME BAKERY LICENSE APPLICATION License Fee: $50.00 (Scott County Iowa)

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HOME BAKERY LICENSE APPLICATION License Fee: $50.00 (Scott County Iowa)

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U.S.A. forms for Scott County Iowa

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Telephone: (563) 326-8618
HOME BAKERY LICENSE APPLICATION
Date of Application:
Anticipated Opening Date:
Mail completed application to:
Scott County Health Department
600 W 4th Street
Davenport, IA 52801
Previous owner name ,
business name , and
license number (if known).
License Fee: $50.00
Establishment Information
Note: A new application is required for change in the business address or ownership.
Name of Business:
Ownership Type:
Owner’s Name:
Business Phone Number:
Alternative or Cell Phone:
Business Email Address:
Physical Business Address:
Suite #:
County:
City
State:
Zip Code:
Person-in-Charge (onsite):
Title of Person-in-Charge:
Person-in-Charge Phone:
Person-in-Charge Email:
Mailing address for all correspondence (if different than above).
Attention:
Telephone Number:
Street or Route:
Suite:
City:
State:
Zip Code:
A Home Bakery Establishment is a licensed bakery located in a residence. A Home Bakery Establishment may prepare
refrigerated or unrefrigerated baked goods for sale directly to household consumers for off-premises consumption or to other
retail outlets. Baked goods that do not require refrigeration may be sold from the residence or at a farmer’s market without a Home
Bakery Establishment License. Baked goods are defined as: breads, cakes, donuts, pastries, buns, rolls, cookies, biscuits and pies
(except meat pies).
Sales Type
(Select all that apply)
☐
☐ Farmer’s Market
☐ Internet
☐ Mail Order
☐ Restaurants
☐ Wholesale
☐ Other specify
Product Information
☐
Breads
☐
Cakes
☐
Pastries
☐
Buns
☐
Rolls
(Select all that apply)
☐ Cookies
☐ Biscuits
☐ Pies
☐ Other specify
License Fee: $50.00
DO NOT COMPLETE INFORMATION BELOW – FOR OFFICE USE ONLY
Check #:
Check Date:
Amount Received
Check Name:
Penalty Amount:
Amount Due:
Applicant’s Name (Print):
Applicant’s Signature:
1/1/2019
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HOME BAKERY LICENSE APPLICATION License Fee: $50.00 (Scott County Iowa)

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Completed 14 February 2021

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