Form Dacs 09215 PDF Details

The Department of Social Services (DSS) FORM DACS 09215, Verification of Need and Eligibility is required to be completed by all applicants for public assistance. This form is used to verify that the household is in need of assistance and meets eligibility requirements. The information provided on this form will be used to determine the amount of assistance a household will receive. Form DACS 09215 must be completed accurately and honestly, as any false or misleading information could lead to a denial of benefits. It is important to understand the questions asked on this form and provide accurate responses. Failure to do so may result in a delay in receiving benefits or being denied altogether. For more information on completing Form Dacs 09215, please visit our website or contact our office toll-free at 1-855-626-9227. We are here to help you!

QuestionAnswer
Form NameForm Dacs 09215
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmartha stewart seed starting worksheet, fdacs forms, premise id florida, 5C-21

Form Preview Example

 

Florida Department of Agriculture and Consumer Services

MAIL OR FAX COMPLETED FORM TO:

 

 

 

Division of Animal Industry

Bureau of Animal Disease Control

 

 

 

Bureau of Animal Disease Control

Division of Animal Industry

 

 

 

 

 

 

 

Cattle Programs Office

 

 

 

 

 

 

 

Room 327, 407 S. Calhoun St.

 

APPLICATION FOR NAIS PREMISES IDENTIFICATION

Tallahassee, FL 32399-0800

 

 

 

 

 

 

 

850/410-0900; Fax 850/410-0957

CHARLES H. BRONSON

 

 

§ 585.145, Florida Statutes,

www.doacs.state.fl.us/ai/

 

5C-3, 5C-4, 5C-5, 5C-6, 5C-7, 5C-9, 5C-20, and 5C-21 Florida Administrative Code

COMMISSIONER

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.

 

 

 

 

 

 

 

 

Business/Farm/Ranch/Stable Account Information

 

 

Business/Premises Name

 

 

Primary Contact

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

City

 

 

 

ST

 

 

ZIP

 

Business Phone

 

 

 

FAX

 

 

 

Mobile Phone

 

 

 

Pager

 

 

 

Email Address

On-site Contact

 

Business or Mobile Phone

 

 

 

(If different from above, Manager, Agent, Stable Manager, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Premises Information (Where animals are located or Florida management headquarters)

 

 

 

Physical (911)

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

City

 

 

ST

 

 

ZIP

 

County

 

 

 

 

 

 

 

Primary Business Function (please check only one)

Production Unit (Farm, Ranch,

Flock, Equine Facility)

Clinic (Location where animals are treated for disease)

Market/Collection Point (Backgrounder, Order Buyer, USDA Approved Market, Approved Dealer)

Exhibition (Fairs, Shows)

Slaughter Plant

Quarantine Facility Tagging Site

Laboratory Rendering

Port of Entry Non-producer Participant

Species on Premises (please check all that apply)

Cattle Poultry

Horses

Chickens

Goats Ducks

Sheep Geese

Swine Guineas

Deer Pheasants

Elk

Quail

Llama Turkeys

Bison Emu

Signature of Applicant or

 

Authorized Agent

Date

DACS-09215 Rev. 01/07

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