Fillable LICENSE APPLICATION Grain Bank only one. Initial Amendment (State of Indiana)

Fill Online, Printable, Fillable, Blank LICENSE APPLICATION Grain Bank only one. Initial Amendment (State of Indiana) Form

Use Fill to complete blank online STATE OF INDIANA (IN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

LICENSE APPLICATION Grain Bank only one. Initial Amendment (State of Indiana)

On average this form takes 33 minutes to complete

The LICENSE APPLICATION Grain Bank only one. Initial Amendment (State of Indiana) form is 4 pages long and contains:

  • 0 signatures
  • 40 check-boxes
  • 114 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of Indiana

BROWSE STATE OF INDIANA (IN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
LICENSE APPLICATION
State Form 20313 (R6 / 7-15)
Approved by State Board of Accounts, 2015
INDIANA STATE DEPARTMENT OF AGRICULTURE
INDIANA GRAIN BUYERS AND
WAREHOUSE LICENSING AGENCY
One North Capitol Avenue, Suite 600
Indianapolis, Indiana 46204
Telephone: (317) 232-1360
Fax: (317) 232-1362
www.IN.gov/isda
Section A:
Initial Amendment (if adding facility or capacity) Check “
” only one.
Section B:
LICENSE TYPE Check “
” only one.
OFFICE USE ONLY
Grain Bank
– A company that stores only grain bank grain and purchases less than fifty thousand (50,000)
bushels of grain per year and has a storage capacity of not more than fifty thousand (50,000) bushels of grain.
File number
Warehouse
– A company that stores grain and purchases less than fifty thousand (50,000) bushels of grain per
year.
Grain Buyer
– A company that purchase annually at least fifty thousand (50,000) bushels of grain from
producers, (which is not for the sole purpose of feeding the company’s own livestock or poultry); offers deferred
pricing, delayed payments, or contracts linked to the commodity futures or commodity options market in connection
with grain purchases. (Includes firms licensed under the U.S. Warehouse Act).
Check number
Buyer/Warehouse
– A company that operates both as a warehouse and as a grain buyer.
Initials
Section C: COMPANY INFORMATION
Name of business
Doing business as (d/b/a) Company’s website address
www.
Individual in charge Title of individual in charge
Address (location and mailing) Contact’s e-mail address
City, State, ZIP code
County Telephone number (Area code) FAX number (Area code)
COMPLETE IF APPLICABLE
CCC (UGRSA) code U.S. Warehouse Act code (Federal code)
Section D: FORM OF BUSINESS ORGANIZATION
Please check “” only one:
Proprietorship
Partnership
Limited Liability Company (LLC)
Corporation
Cooperative
Other, specify: __________________________________________
Fiscal year closing date (month, day, year)
A reviewed level Financial Statement, prepared by a qualified accountant, is required
and must be sent in with this application.
Section E: FORMAL APPLICATION AND CERTIFICATION
I hereby make application for License for the company identified above, under the provisions of the Indiana Grain Buyers and Warehouse Licensing and
Bonding Law, IC 26-3-7. I understand and agree, as a condition to the issuance of such a license, to make my business premises, records and inventories
available for inspection by the Indiana Grain Buyers and Warehouse Licensing Agency, and to cooperate and assist in such inspections. I affirm, under the
penalties provided for in the law, that the information in this application is true and accurate to the best of my knowledge and belief.
Typed or printed name of applicant Signature of applicant
Date (month, day, year)
IGBWLA Director’s approval Date of approval (month, day, year)
Continued on next page
Reset Form
Section F: CALCULATION OF LICENSING FEES
1). Licensing Fee
(includes one (1) facility):
Enter application fee:
GRAIN BANK:……………………………………………………………$ 1,000.00
GRAIN BUYER:………………………………………………………….$ 1,500.00
WAREHOUSE and BUYER/WAREHOUSE:
Less than 250,000 bushel storage capacity…………………………….$ 1,000.00
250,000 thru 999,999 bushel storage capacity………………………..$ 1,500.00
1,000,000 thru 10,000,000 bushel storage capacity………………….$ 2,000.00
Over 10,000,000 bushel storage capacity………………………….. $ 2,500.00
$
(1)
2). Number of facilities, less one included in the above fee:
(List Indiana facilities on pages 3 & 4, Section J.)
(2)
3). Multiply Line 2 by $250.00
$
(3)
4). Total of Lines 1 and 3: Make check payable to: Indiana Grain Buyers and Warehouse Licensing Agency
$
(4)
Section G: COMPUTATION OF NET WORTH REQUIREMENTS
1). Indiana law MINIMUM NET WORTH requirements are: Enter applicable Net Worth requirement:
GRAIN BANK – only grain bank, 50,000 bu capacity and buys less than 50,000 bu……………….$100,000.00
WAREHOUSE – only stores grain and buys less than 50,000 bu per year…………………………..$100,000.00
GRAIN BUYER – buys more than 50,000 bu per year, offers DP and contracts, no storage………$100,000.00
BUYER/WAREHOUSE – Less than 1 million bushels of capacity or purchases…………………….$150,000.00
1 million or more bushels of capacity or purchases……………………….$200,000.00
See Section B, License Type, for more information
$
(1)
2). Total bushel storage capacity of all facilities. (To be listed on page 4).
(Warehouse and Buyer/Warehouse applicants only).
(2)
3). Multiply Line 2 by ten cents (.10¢)
$
(3)
4). TOTAL: (Line 1 and Line 3)
$
(4)
5). Total number of bushels purchased last year.
(Grain Buyer and Buyer/Warehouse applicants only).
(5)
6). Multiply Line 5 by five cents (.05¢)
$
(6)
7). TOTAL REQUIRED NET WORTH: Enter the larger of Lines 4 or 6.
By July 1, 1999, all firms must meet this requirement and a Current Asset to Current Liability ratio of one to one (1:1).
$
(7)
8). Company’s current NET WORTH (as of _______/_______/_______) from reviewed financial statement.
$
(8)
9). If your Net Worth is equal to or greater than the requirement, continue to Section H.
IMPORTANT: Net Worth (Line 8) must be at least the minimum required (Section G, Line 1) to add the deficient
amount to the bond. If the required Net Worth (Line 7) is greater than your Net Worth (Line 8), enter the deficiency
here and in Section H, Line 8.
$
(9)
Section H: COMPUTATION OF BOND
1). Minimum Amount of Bond Required.
$ 50,000.00
(1)
2). Total bushel storage capacity of all facilities listed on page 4, Section K.
(Grain Bank, Warehouse, and Buyer/Warehouse applicants only). (2)
3). Multiply Line 2 by ten cents (.10¢)
$ (3)
3a). Total of Lines 1 & 3
$
(3a)
4). Total dollar amount paid for grain purchased from producers during last fiscal year.
(Grain Buyer and Buyer/Warehouse applicants only).
$ (4)
5). Multiply Line 4 by ½ % (.005).
$
(5)
6). Enter the larger amount of Lines 1, 3a, or 5.
$
(6)
7). BOND REQUIRED: Enter the smaller of Line 6 or $250,000.00.
(Companies applying for more than one license, bond not to exceed $1,000,000.00 for company.)
$
(7)
8). If the minimum Net Worth requirement is met, Net Worth deficiencies can be added to the bond requirement.
Enter deficiency in required Net Worth from Section G, Line 9.
$
(8)
9). TOTAL BOND REQUIRED: Lines 7 plus Line 8.
$
(9)
Carrier of bond, if known: Form of bond?
Surety Cash Deposit Letter of Credit
License Application – Page 2
0.00
0.00
0.00
0.00
Section I: INSURANCE
A.
B.
Provide a Certificate of Insurance as evidence that you have an effective policy of insurance which:
Insures, in your business name, ALL GRAIN in the facilities for which you are seeking a license from Indiana Grain Buyers and Warehouse Licensing
Agency, for the full market value of that grain against loss by fire, internal explosion, lightning and windstorm, And…
Is issued by an insurance company authorized to do business in Indiana: (enter the name of insurer below).
Name of insurer Policy number
Section J: INDIANA FACILITY INFORMATION
Name of facility File number
Doing business as (d/b/a)
Individual in charge Title of individual in charge
Address (location and mailing) Branch contact’s e-mail address
City, state, ZIP code
County Telephone number (Area code) FAX number (Area code)
Capacity in bushels Capacity calculated by?
State Chart Federal Chart Company Computation
Name of facility File number
Doing business as (d/b/a)
Individual in charge Title of individual in charge
Address (location and mailing) Branch contact’s e-mail address
City, state, ZIP code:
County Telephone number (Area code) FAX number (Area code)
Capacity in bushels Capacity calculated by?
State Chart Federal Chart Company Computation
Name of facility File number
Doing business as (d/b/a)
Individual in charge Title of individual in charge
Address (location and mailing) Branch contact’s e-mail address
City, state, ZIP code
County Telephone number (Area code) FAX number (Area code)
Capacity in bushels Capacity calculated by?
State Chart Federal Chart Company Computation
Additional Indiana Facilities continued on page 4.
License Application – Page 3
Section J: INDIANA FACILITY INFORMATION CONTINUED
Name of facility File number
Doing business as (d/b/a)
Individual in charge Title of individual in charge
Address (location and mailing) Branch contact’s e-mail address
City, state, ZIP code
County Telephone number (Area code) FAX number (Area code)
Capacity in bushels Capacity calculated by?
State Chart Federal Chart Company Computation
Name of facility File number
Doing business as (d/b/a)
Individual in charge Title of individual in charge
Address (location and mailing):
Branch contact’s e-mail address
City, state, ZIP code
County Telephone number (Area code) FAX number (Area code)
Capacity in bushels Capacity calculated by?
State Chart Federal Chart Company Computation
Name of facility File number
Doing business as (d/b/a)
Individual in charge Title of individual in charge
Address (location and mailing):
Branch contact’s e-mail address
City, state, ZIP code
County Telephone number (Area code) FAX number (Area code)
Capacity in bushels Capacity calculated by?
State Chart Federal Chart Company Computation
(If more than six (6) Indiana facilities, please attach a separate list.)
STORAGE CAPACITIES
1). Total Capacity of facilities listed on the application:
(1)
2). Total Capacity of facilities listed on attached list:
(2)
3). TOTAL Capacity of ALL facilities:
(3)
The following MUST be received by the Agency before a license can be issued:
Application Check for License Fee Bond Reviewed Level Financial Statement Certificate of Insurance
Aged accounts receivable listing (90 days, 120 days, and more than 120 days due) Daily position record for the end of the fiscal year
Please complete each section entirely and return the application with fees to:
Indiana Grain Buyers and Warehouse Licensing Agency, One North Capitol Avenue, Suite 600, Indianapolis, Indiana 46204
Make checks payable to: Indiana Grain Buyers and Warehouse Licensing Agency (IGBWLA).
0.00
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

LICENSE APPLICATION Grain Bank only one. Initial Amendment (State of Indiana)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 13 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document