Nursery Certificate Form PDF Details

Are you looking for guidance on completing a nursery certificate form? Do you need to know what requirements must be met in order to successfully complete the application? Well, you've come to the right place! In this blog post, we'll provide an overview of the nursery certificate form and explain what information is required from applicants. We'll also discuss how certified nurseries operate and how they benefit both providers and consumers. Whether you are a professional working in childcare or simply want some insights into how the certification process works, read on for clear guidance and advice.

QuestionAnswer
Form NameNursery Certificate Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesnursery texas department, floral texas license, texas floral certificate, tx agriculture certificate

Form Preview Example

P.O. Box 12076 Austin, Texas 78711 (800) 835-5832 (512) 463-7476

Hearing impaired: (800) 735-2988 voice (800) 735-2989 (TTY)

www.TexasAgriculture.gov

TEXAS DEPARTMENT OF AGRICULTURE

RNF-500

Nursery-Floral Certificate Application

You must complete ALL licensing activity (including testing) within one year of the application date. An incomplete application shall become void on the one-year anniversary of submission. A void application will not be processed and any application fee associated with the void application shall not be refunded.

 

 

 

1 REGISTRATION INFORMATION - PLEASE INDICATE THE CLASS OF CERTIFICATE YOU ARE APPLYING FOR

 

 

 

 

CLASS 1

Businesses selling but not growing nursery/floral stock, such as garden centers, floral shops, stores, landscape

 

 

$75 00

contractors, interior decorators, street vendors, etc.

 

 

 

 

 

 

 

CLASS 2

Businesses that sell nursery/floral stock and have a growing area of 435,600 sq. ft. (10 acres) or less.

 

A

$110 00

 

 

 

SECTION

 

CLASS 4

Businesses that sell nursery/floral stock and have a growing area of 871,201 sq. ft. or more (over 20 acres).

 

 

 

CLASS 3

Businesses that sell nursery/floral stock and have a growing area of 435,601 sq. ft. – 871,200 sq.ft. (in excess of 10

 

 

$145 00

acres to 20 acres).

 

 

 

 

 

 

$180 00

 

 

 

 

 

CLASS M

Businesses that sell, lease, or distribute nursery products and/or floral items at temporary location such as flea markets,

 

 

$180 00

arts and craft shows, plant or flowers shows, or other temporary markets.

 

 

 

A Class M license consists of thirty Event Permit. See instructions for more information regarding Event Permits.

 

 

 

 

 

 

SECTION B

1TYPE OF APPLICATION

 

 

New Business

Change of Ownership – previous certificate number:

Change of Location – previous certificate

 

 

 

_________________

 

number: _________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License Should Become Effective

/

/

REGISTRATION IS NOT VALID UNTIL APPROVED BY TDA.

 

 

 

 

Month

day

year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2BUSINESS TYPE

 

 

 

 

 

 

TDA USE ONLY

 

 

 

 

 

 

Corporation

 

 

Sole Proprietorship

 

 

Client No.

 

 

Account No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Limited Liability Co.

 

 

Government

 

 

 

 

 

 

 

 

 

 

Limited Partnership

 

 

Organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date (mm/dd/yy)

 

 

Initials

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General Partnership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C

3CLIENT INFORMATION

Full legal business name (owner’s name if sole proprietor – no aliases)

D.B.A. (if applicable)

Comptroller Taxpayer ID No.(In-state businesses)

 

Federal ID No.(Out-of-state businesses and nonprofit org. )

 

 

 

 

SOLE PROPRIETORSHIP ONLY

 

 

 

 

 

 

Social Security No. (SSN - Required)

If you do not have an SSN you must a attach form Affidavit for Occupational

-

-

 

License - No Social Security Number (OGC-001) available at

 

www.TexasAgriculture.gov

 

 

 

 

 

 

 

 

 

Driver License No.

____________________ (if SSN is not available)

TX

State Issued ID No.

____________________ (if DL is not available)

Other _________

 

 

 

 

 

 

Licensing Department

Revised 4/5/18

Administrative Services Division

 

RNF-500 Nursery-Floral Certificate Application

Page 2 of 4

Legal Business Name _________________________

 

1RESPONSIBLE PERSON INSTRUCTIONS

Please list the full legal name (no aliases or nicknames) of the primary person responsible for the business, as indicated:

For a corporation, limited liability company, or cooperative, the president or CEO,

For a limited or general partnership, the managing partner or general manager,

For a sole proprietorship, the owner,

For any other type of business, the general manager.

 

CONTD.C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 RESPONSIBLE OFFICER, PARTNER, MANAGER, OR OWNER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name

 

 

M. I.

Last Name

 

 

 

 

 

 

 

 

SECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone No.

 

 

 

E-mail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

-

Ext.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

RESPONSIBLE PERSON MAILING ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Web Address of Business (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

CONTACT FOR LICENSE-RELATED MATTERS

SAME AS RESPONSIBLE OFFICER

 

 

 

 

 

 

First Name

 

 

M. I.

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Phone

 

 

 

Secondary Phone (optional)

 

 

 

 

 

(

)

-

Ext.

 

(

)

-

 

Ext.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fax (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

-

Ext.

 

 

 

 

 

 

 

 

 

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-mail Address

 

 

 

 

 

 

 

 

 

 

 

 

SECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

***Important Note*** I understand that my email address is required for the Texas Department of Agriculture to keep me informed of

 

 

 

 

 

 

 

 

critical information, including licensing and regulatory updates; renewal invoices; and other important communications. Failure to provide an

 

 

 

 

email address may result in my not receiving time-sensitive information that could affect my compliance with state regulations, thereby,

 

 

 

 

resulting in monetary penalties.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

MAILING ADDRESS

SAME AS CLIENT MAILING ADDRESS

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

 

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Licensing Department

Revised 4/5/18

Administrative Services Division

RNF-500 Nursery-Floral Certificate Application

Page 3 of 4

Legal Business Name _________________________

 

SECTION E

1FACILITY INFORMATION

Facility Name

2PHYSICAL ADDRESS OF LOCATION OF LICENSEE, LICENSED ACTIVITIES OR EQUIPMENT

Address (No P.O. Box)

City

State

Zip

County

 

 

 

 

Directions to Physical Location if address above is difficult to find

SECTION F

1OUT-OF-STATE APPLICANTS ONLY

An applicant for a Nursery-Floral license whose principal place of business is situated outside the State of Texas must appoint and designate a resident citizen of Texas as said applicant’s resident agent within Texas. If the address provided in Section C is out of state resident agent

information is REQUIRED.

Resident Agent Name

Resident Agent Address

City

Zip

Business Phone

( ) -

SECTION G

1PAYMENT

Please see instructions for applicable fees.

Method of Payment

(payable to Texas Department of Agriculture)

 

 

 

 

 

Check #

 

 

Cashier’s Check #

 

 

Money Order #

 

 

 

 

 

 

 

 

 

 

Amount remitted

 

 

 

 

 

Mail to: Texas Department of Agriculture

$

 

 

 

 

 

 

P.O. Box 12076, Austin, TX 78711-2076

 

 

 

 

 

 

TDA USE ONLY

 

Receipt No.

 

Date Receipt Issued

 

 

 

 

 

 

 

 

 

 

 

 

Licensing Department

Revised 4/5/18

Administrative Services Division

 

RNF-500 Nursery-Floral Certificate Application

Page 4 of 4

Legal Business Name _________________________

 

SECTION H

1SIGNATURE

The applicant, by and through their personal or agent's signature below (1) certifies that all information provided in connection with this application at any time is true and correct to the best of the applicant's knowledge; (2) acknowledges that any misrepresentation or false statement made by the applicant, or an authorized agent of the applicant, in connection with this application, whether intentional or not, will constitute grounds for denial, revocation, or non-renewal of any license issued pursuant to this application and/or assessment of monetary administrative penalties; and (3) if applying as an individual, further acknowledges that this application may be denied and that any license issued pursuant to this application may be suspended, revoked, or denied renewal due to delinquency in payment of a guaranteed student loan and that any license issued pursuant to this application may be suspended or denied renewal for failure to pay child support. If signed by an agent (including employee) of the applicant, the person signing certifies that he or she is authorized to make the preceding certifications on behalf of the applicant.

Applicant Name

Title

 

 

 

 

Applicant Signature

Date

(mm/dd/yy)

 

 

 

SECTION I

1CHECKLIST

Please use this checklist to ensure you are sending all of the necessary information and documents.

Nursery-Floral Certificate Application

Fee (see instructions for correct fee.)

Nursery-Floral Event Permit Request, if applicable.

Integrated Pest Management Plan, if applicable.

Please note that an incomplete application may result in processing delays.

This document becomes public record and is subject to disclosure. With few exceptions, you have the right to request and be informed about the information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government Code, Sections 552.021, 552.023, and 559.004.)

Licensing Department

Revised 4/5/18

Administrative Services Division

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