NIPM Item # 2.1
State of California, DEPARTMENT OF FOOD AND AGRICULTURE
Pest Exclusion/Nursery, Seed and Cotton Programs
New
Renewal
64-029 (Rev. 1/11)
Previous License#___________
Branch
Departmental Use Only
Change of Ownership
Change of Address Only
APPLICATION FOR
Lic. No. ______________
Growing Ground Addition
LICENSE TO SELL NURSERY STOCK
Temp. Lic. ____________
Change of Name Only
Annual Lic
Please print or type information in spaces where indicated. Complete ALL sections.
FIRM NAME OR DBA & MAILING ADDRESS (AS IT WILL APPEAR ON YOUR LICENSE):
SALES LOCATION (GIVE SPECIFIC ADDRESS, NOT P. O. BOX):
COUNTY:
CITY:
ZIP:
TELEPHONE:
FAX:
CONTACT PERSON:
TELEPHONE:
# OF ACRES FOR THIS LOCATION
OWNER’S NAME(S) OR PARENT CORPORATION NAME:
E-MAIL ADDRESS:
P A R T I
C A L C U L A T E Y O U R F E E S H E R E
1. BASIC LICENSE FEE
150.00
1a.
$
0
1.0
acres . . . $
0
2. ACREAGE FEE:
Required for land in excess of one
2a
Please check this box if you
1.01
-
5.0
acres . . . $ 100
acre used in the production, sale or storage of nursery stock
qualify for the acreage fee exemption AND
(Include growing grounds acreage from reverse side in this
5.01
-
20.0
acres . . . $ 250
enter zero fees in box 2b below
calculation)
20.01
-
50.0
acres . . . $ 400
List total # acres to assist in calculating the fee
50.01
-
200.0
acres . . . $ 600
200.01
-
500.0
acres . . . $ 800
2b.
Calculate your acreage fees due and
ACREAGE FEE EXEMPTION*:
If greater than 75% of
enter amount here (Do not include
500.01
-
+
acres . . . $ 900
your nursery’s gross income comes from sales of cut
fractions of an acre in calculations.)
-
flowers/cut ornamentals, you do not need to pay the acreage
LIST
# ACRES
TOTAL
=
fee. Check box 2a and enter zero fees in box 2b. List total #
$
acres in box to right (examples: 0.25, 1.5, 12)
3. TOTAL FEES DUE (Add total of 1a and 2b and enter in 3a)
3a. TOTAL DUE
$
SEND THIS APPLICATION ALONG WITH CHECK OR MONEY ORDER PAYABLE TO: “CDFA –90054” AND MAIL TO:
CASHIER
California Department of Food and Agriculture
1220 N Street
Sacramento, California 95814
NOTE: Allow six to eight weeks for license processing.
P A R T I I T Y P E O F B U S I N E S S ( Check one or more and answer questions below. See reverse for business descriptions.)
Producer
Cut Flowers/Cut Ornamentals
Jobber/Broker/Commission Merchant
Retailer
Incidental Retailers
Landscaper
Do you have growing grounds?
YES
NO
Do you intend to sell at Farmers’ Markets?
YES
NO
If yes, please fill in Part IV on reverse side.
If yes, please fill in Part V on reverse side.
P A R T I I I T Y P E O F N U R S E R Y S T O C K ( Check as many as applicable. Commercial producers must complete this section.)
1. Coniferous evergreens
7. Bulbs, corms, rhizomes, etc.
D. Other subtropical & tropical
fruit trees, including avocado
2. Broad-leaved evergreens
8. Decorative plants, foliage or florist’s
E. Strawberry, bushberry, etc.
potted plants, including orchids
3. Deciduous shade trees
9. Cacti and succulents
F. Vegetable plants
4. Deciduous shrubs
A. Deciduous fruit & nut trees**
G. Sod (turfgrass)
(see reverse)
5. Rose plants
B. Grapevine and kiwi plants**(
)
H. Ground covers
see reverse
6. Herbaceous ornamental annuals and
J. Palms
(
)
C. Citrus trees**
see reverse
perennials and aquatics
I hereby certify that the information submitted in this application is true and correct to the best of my knowledge and belief.
SIGNATURE OF AUTHORIZED REPRESENTATIVE
OFFICIAL TITLE
DATE