LIVESTOCK MARKET LICENSE APPLICATION
TENNESSEE DEPARTMENT OF AGRICULTURE
DIVISION OF CONSUMER & INDUSTRY SERVICES – ANIMAL HEALTH
P. O. Box 40627, Nashville, Tennessee 37204
Phone: 615/837-5120, Fax 615/837-5250 Animal.health@tn.gov
LIVESTOCK MARKET NAME: __________________________________________________________________________________
PERSON, CORPORATION, LLC, OR PARTNERSHIP TO WHOM THE LICENSE IS TO BE ISSUED:
EMAIL ADDRESS: ______________________________________________________________________________________________
PHYSICAL ADDRESS OF MARKET |
MAILING ADDRESS OF MARKET (if different) |
______________________________________________________ |
______________________________________________________ |
Street or Route |
Street or Route |
______________________________________________________ |
______________________________________________________ |
City, State, Zip Code |
City, State, Zip Code |
MARKET PHONE NUMBER(S): __________________________________________________________________________________
NAME(S), ADDRESS (ES), AND PHONE NUMBER(S) WHERE OPERATOR(S) CAN BE REACHED AT ALL TIMES (use back of form if additional space needed):
______________________________________________________ |
______________________________________________________ |
Name |
Name |
______________________________________________________ |
______________________________________________________ |
Street or Route |
Street or Route |
______________________________________________________ |
______________________________________________________ |
City, State, Zip Code |
City, State, Zip Code |
______________________________________________________ |
______________________________________________________ |
Phone Number(s) (home and cellular, if applicable) |
Phone Number(s) (home and cellular, if applicable) |
DESCRIPTION OF MARKET (type of construction, square footage under roof, number of pens, etc.): ______________________
________________________________________________________________________________________________________________
__________________________________________________________________________________ _____________________________
REGULAR SALE DAY(S) AND TIME(S): __________________________________________________________________________
OTHER SALES AND DAY(S) CONDUCTED: _______________________________________________________________________
TYPE(S) AND ANNUAL VOLUME OF LIVESTOCK TO BE SOLD (Volume to be based on past annual sales. If no past sales, then good faith projection of sales for next calendar year):
CATTLE: _________________ EQUINE: _________________ HOGS: _________________ GOATS _________________
SHEEP _________________ OTHER/ALTERNATIVE LIVESTOCK (specify): _______________________________________
THE FOLLOWING MUST BE ENCLOSED BEFORE A LICENSE WILL BE ISSUED:
(1)Annual fee of $100.00, made payable to the Tennessee Dept. of Agriculture and sent to address at top of form.
(2)Proof the applicant has met bonding requirements of 9 C.F.R. 201
(3)Copy of current, valid property and fire insurance for market.
I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED IN THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE.
_________________________________________ |
________________________________________ |
________________________ |
Signature* |
Title (if applicable) |
Date |
*Must be an individual person or person authorized to bind corporation, partnership, Limited Liability Company or other legal entity.
LICENSE IS VALID FROM JULY 1 THROUGH JUNE 30
AG-0675 (Rev. 11/13)
