Form Pi 017S Michigan PDF Details

The Michigan Department of Agriculture's PI-017S form, crucial for nursery stock dealers and growers, serves as an application for obtaining or renewing a license in line with the provisions of the 1931 Public Act 189, as amended. Required to be filled out by businesses engaging in these agricultural activities, this comprehensive document gathers essential information on the business, including name, address, contact details, and corporate ownership or management specifics. Available for both new applicants and those seeking renewal, it indicates the type of license sought—either a Grower License or a Dealer License, with specific categories for general nursery stock growers, nursery stock dealers, and market operations. It also mentions the need for inspection for certain licenses, thereby ensuring compliance with state regulations. The form outlines the non-refundable fees associated with each type of license and provides instructions for payment, underscoring the state's commitment to regulating the industry to promote healthy agricultural practices. Additionally, it requires applicants to submit a Federal/Tax ID and, if applicable, a copy of their Doing Business As (DBA) certification. This form represents a vital step for businesses in the agriculture sector within Michigan to legally operate, emphasizing the state's support for agricultural enterprise while ensuring the integrity and safety of its horticultural activities.

QuestionAnswer
Form NameForm Pi 017S Michigan
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslicensing, refundable, CEO, Grower

Form Preview Example

Michigan Department of Agriculture PI-017s (05/09)

P.O. Box 30746, Lansing, MI 48909-8246517-241-6666

In accordance with 1931 Public Act 189, as amended.

Nursery Stock Dealer & Grower License Application

License Year Ending: _______Status:

 

New

 

Renewal

 

No Longer Needed

If Renewal, License No. of Establisment _______________________________________

Business Information

Business Name:__________________________________________________________

Business Address:________________________________________________________

City:________________________________________________ State: _______________

County:______________________________________________ Zip:_______________

Business Phone: (_____)_____________ Business Fax:(_____)____________________

Business Email:__________________________________________________________

Mailing address if different from above: Street or P.O. Box:___________________________

__________________________________________________________________________

______________________________

Corporate/Owner Information

 

Ownership Type:

Corporation

Sole Ownership

Partnership

L.L.C.

Other: Specify_____________________

 

Corporation Name: _______________________________________________________________________________________

 

Owner/President (CEO) Name:______________________________________________________________________________

 

Street Address of Corporation or Owner:_______________________________________________________________________

 

City:______________________________________________________________________ State: _______ Zip:_____________

 

Phone: (_____)_____________ Fax:(_____)_______________ Email:_______________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Cell Phone: (_____)_____________ DBA Expiration Date: ____________________________

Federal/Tax ID #

 

 

 

 

 

 

 

 

 

 

 

 

(Submit copy of DBA w/ application.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License Fees (NON-REFUNDABLE)

 

 

 

 

 

 

 

 

 

 

Grower License

 

AOBJ: 0185

Dealer License

 

 

AOBJ: 0342

 

 

 

 

 

 

 

 

 

General Nursery Stock Grower $100

 

Nursery Stock Dealer $100

 

(

Inspection Required

)

 

 

 

Nursery Stock Dealer Market $100

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Small Scale Grower* $40

Small Scale Grower Market* $40

 

*eligibility determined by MDA

 

Both $40 fees: AOBJ: 0341

Payment Method: Check/Money Order No. _________________________________________ Amount enclosed: _______________

Please make check/money order payable to the State of Michigan and submit to the address at the top of the page.

Signature:__________________________________________________ Date:___________________

Please print your name here:___________________________________________________________

Title:______________________________________________________________________________

www.michigan.gov/mda-licensing

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