Agr Form 702 4280A PDF Details

Every year, agricultural producers in the United States must file an Agr Form 702 4280A to report their production and marketing of agricultural products. The form is used to calculate the producer's share of the national Agricultural Marketing Service (AMS) livestock and grain price reporting program. Producers who fail to file the form may face penalties. This article will provide a brief overview of the Agr Form 702 4280A, including what information is required and when it must be filed.

QuestionAnswer
Form NameAgr Form 702 4280A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdECLARACIN, agr form 702 4280a, LicensingEd, usted

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COUNTY

 

 

 

 

 

OFFICE USE ONLY

 

 

 

 

 

 

 

 

CASHIER USE ONLY

 

 

 

 

 

ISSUED:__________________________

 

 

 

 

 

 

 

 

 

 

 

 

Pesticide Management Division

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2014 PESTICIDE/SPI

 

 

 

 

 

 

 

 

 

 

 

PO Box 42591

 

 

 

 

 

 

 

 

 

 

 

 

Olympia, WA 98504-2591

LICENSE RENEWAL APPLICATION

 

 

 

 

 

 

Toll Free 877-301-4555

 

 

 

 

 

 

E-mail: license@agr.wa.gov

Except where noted, all licenses expire 12/31/14.

 

 

 

 

INSTRUCTIONS

(1) Mark license(s) you wish to renew in Section 1. Note: WSDA now has an online renewal option. See website for details.

 

(2) Determine fee. Renewals submitted after January 1 require the penalty fee in addition to the license fee indicated or

 

 

 

 

 

 

completion of the penalty fee exemption statement at the bottom of this form.

 

 

 

 

 

 

(3) Fee for Structural Pest Inspector license is not required if renewing any one of the ive license types in bold (the license

 

 

 

types listed above Structural Pest Inspector).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4) Select Application Method (if applicable). Complete Section 2 --

Applicant Information.

 

 

 

 

 

 

(5) Instruct WSDA how you would like to be notiied when your license is updated by completing Section 3.

 

 

 

 

 

(6) Please send completed form with appropriate fee to WSDA at the address above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 1 – LICENSES TO RENEW

 

 

 

 

 

 

 

 

RENEWAL FEE

 

 

 

 

LICENSE TYPE

 

 

EXPIRES

FEE PENALTY FEE*

 

 

 

 

 

 

 

 

 

 

Commercial Operator

12/31/13

$67

$67

 

 

 

 

 

 

TOTAL LICENSE FEE(S)

$ ______________________

 

 

 

Private Commercial

.........................

 

12/31/13

$33

$33

 

 

 

 

 

 

 

 

 

7101

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial Consultant

12/31/13

$60

$60

 

 

 

 

 

 

PENALTY FEE(S)

$ ______________________

 

 

 

Public Consultant

 

12/31/13

$33

$33

 

 

 

 

 

 

 

 

 

7102

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Demo & Research

 

12/31/13

$33

$33

 

 

 

 

 

 

TOTAL REMITTANCE

$ ______________________

 

 

 

Structural Pest Inspector**

12/31/13

$60

$60

 

 

 

 

 

 

Make checks payable to WSDA. Please do not send cash.

 

 

 

Dealer Manager

 

12/31/13

$33

$33

 

 

 

 

 

 

Checks returned by the bank will be charged a handling

 

 

 

Public Operator

 

12/31/13

$33

$33

 

 

 

 

 

 

fee of $25.00 (RCW 62A.3.515(a) and 62A.3.520.).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Private Applicator (PA)

12/31/13

$33

$33

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICATION METHOD

 

 

 

Limited Private Applicator (LPA)

5 years

$33

$33

 

 

 

 

 

 

 

 

 

 

Rancher Private Applicator (RPA)

5 years

$100

$25

 

 

 

 

 

 

 

(Check all that apply)

 

 

 

(Note: No fee required for PA, LPA or RPA license if renewing

 

 

 

 

 

 

 

AIR GROUND

CHEMIGATION

 

 

any other WSDA pesticide license for which a fee is paid.)

 

 

 

 

 

 

 

Do you apply fertilizers through irrigation equipment? Yes

 

 

**see instructions #3 above

 

 

*see instructions #2 above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 2 – APPLICANT INFORMATION

 

 

 

 

NAME (Last, First, Middle) PLEASE PRINT CLEARLY

 

SOCIAL SECURITY NUMBER

 

 

 

LICENSE NUMBER

BIRTHDATE

 

 

 

 

 

 

 

(Required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MONTH

DAY YEAR

 

HOME MAILING ADDRESS (PO Box or Street Address)

 

 

E-MAIL ADDRESS

 

 

 

 

 

 

 

HOME TELEPHONE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPANY / AGENCY NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPANY/AGENCY TELEPHONE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

COMPANY / MAILING ADDRESS (PO Box or Street, City, State, Zip)

SECTION 3 – LICENSEE NOTIFICATION

Yes, I need a new plastic card

Notify me of license update by (mark one only):

 

E-mail (be sure to neatly print e-mail address in Section 2 above)

 

Postal mail

 

None. I will periodically check the WSDA website at agr.wa.gov/PestFert/LicensingEd/Search/

 

 

PENALTY FEE EXEMPTION STATEMENT

DECLARACIÓN DE EXCEPCIÓN DE PAGO DE MULTA

If you are applying for a renewal after January 1 and you have not performed

Si usted está solicitando renovar su licencia después de 1ro de enero y no realizado

work requiring your license(s), you are exempt from the penalty fee. You must

ningún trabajo que requería su(s) licencia(s), usted está excepto de pagar la multa.

sign the statement below verifying your exemption status.

 

Usted debe irmar la siguiente declaración para veriicar su estatus de excepción.

I hereby state that I have not operated as a

 

Yo declaro por este medio que no he operado

 

__________________________________________________________

_________________________________________________________________

LIST ALL LICENSES FOR WHICH THIS EXEMPTION APPLIES

ANOTE TODAS LAS LICENCIAS QUE CALIFICAN PARA ESTA EXCEPCIÓN

since the expiration of my last license and am therefore exempt from the penalty fee(s).

desde la expiración de mi licencia, y por tanto, estoy excepto de pagar la(s) multa(s).

__________________________________________________________

_________________________________________________________________

SIGNATURE OF APPLICANT

DATE

FIRMA DEL SOLICITANTE

FECHA

 

 

 

 

AGR FORM 702-4280A (R/9/13) Page 1 of 2

WSDA Pesticide License Types

Note: All licenses expire annually on 12/31/14, with the exception of Limited & Rancher Private Applicator licenses, which are ive year licenses expiring on December 31st of the ifth year.

 

LICENSE TYPE

DEFINITIONS

 

Commercial Operator

A person employed by a commercial applicator to apply pesticides to the land of

 

Fee: $67.00

another. This land can either be publicly or privately owned. The commercial

 

 

operator license is not valid unless working for a licensed commercial applicator.

 

Commercial Applicator

A person engaged in the business of applying pesticides to the land/property of

 

Fee: $215.00

another. This land can either be publicly or privately owned.

 

 

NOTE: Use "Commercial Pesticide Applicator License Application" (AGR

 

 

702-4241) to apply for this license.

* Structural Pest Inspector

A person who inspects a structure for wood destroying organisms or conditions

 

Fee: $60.00

conducive to their development. Wood destroying organisms include carpenter

 

 

and moisture ants, termites, wood infesting beetles and wood rot (fungus). This

 

 

license is required in addition to any license needed to apply, consult or

 

 

distribute pesticides. Proof of inancial coverage required. Go to http://agr.wa.gov/

 

 

PestFert/LicensingEd/CaSpiInfo.aspx for further information.

 

Private-Commercial Applicator

A person who applies or supervises the use of a "restricted use" pesticide on

 

Fee: $33.00

land owned or rented by him or his employer for purposes other than the production

 

 

of an agricultural commodity.

 

Dealer Manager

A person who supervises the distribution of pesticides (other than home and gar-

 

Fee: $33.00

den products) from a pesticide dealer outlet. The dealer manager license is not

 

 

valid unless working for a licensed Pesticide Dealer outlet.

** Public Operator

A person who, while acting as an employee of a governmental agency, applies

 

Fee: $33.00

"restricted use" pesticides by any means or general use pesticides by power

 

 

equipment on public or private property. The public operators license is not valid

 

 

unless working for a public agency.

**Public Pest Control Consultant A person who, while acting as an employee of a governmental agency, offers or

Fee: $33.00

supplies technical advice, supervision, aid or makes recommendations to any

 

user of non-home and garden pesticides. The public pest control consultant license

 

is not valid unless working for a public agency.

Commercial Pest Control

A person who sells or offers pesticides for sale at other than the licensed pesti-

Consultant

cide dealer outlet from which they are employed. In addition, commercial consultants

Fee: $60.00

may offer or supply technical advice, aid, or make recommendations to the users

 

of non-home and garden pesticides. Licensed and employed commercial applica-

 

tors and commercial operators may act as commercial consultants without acquiring

 

the license.

Demonstration & Research

A person who applies or supervises the use of any experimental use pesticide or

Fee: $33.00

any "restricted use" pesticide at no charge to small experimental plots for re-

 

search purposes.

Private Applicator

A person who applies or supervises the use of any pesticide through chemigation

Fee: $33.00

equipment or a "restricted use" pesticide on land owned or rented by him

 

or his employer for the purpose of producing an agricultural commodity.

 

No fee required if applicant pays for another qualifying WSDA pesticide license.

Limited Private Applicator

Both licenses allow holder to apply or supervise the use of restricted use

Fee: $33.00

herbicides on non-production agricultural land (pastures, rangeland, areas around

Rancher Private Applicator

farm buildings) and in mixed rangeland-timber areas to control weeds designated

Fee: $100.00

for mandatory control. Rancher Private Applicators may also apply herbicides and

 

rodenticides to limited production agricultural land where hay and grain are

 

grown primarily for on-farm use. Neither license allows the use of restricted use

 

insecticides, fungicides or aquatic herbicides. No fee required for either license

 

if applicant pays for another qualifying WSDA pesticide license. Both are valid in

 

Eastern Washington only.

*The fee is not required if applicant holds and is working under the authority of a current Commercial Applicator, Commercial Operator, Private Commercial Applicator, Commercial Consultant, Demonstration & Research, Public Operator or Public Consultant license.

**Public agency purchase orders are not accepted. State agencies may pay with a journal voucher (JV) crediting agency 495, fund 126.

AGR FORM 702-4280A (R/9/13) Page 2 of 2