Form Ag-03007 Apiary Inspection Application - Minnesota Department Of Agriculture printable pdf download

Form Ag-03007 Apiary Inspection Application - Minnesota Department Of Agriculture

Plant Protection Division, Ph. 651-201-6095

Minn. Stat. 17.445

APPLICATION FOR APIARY INSPECTION

Please complete all of the information requested. For assistance in completing your application form, please call (651) 201-6095.

Legal Name:

Phone Number:

DBA:

Back-Up Phone Number:

Mailing Address:

City:

State:

Zip Code:

Email:

Expected Date of Departure: ___________/___________/______________

Preferred Inspection Date is between____________________________ and _____________________________

List all counties where inspections are to be performed:

Instructions:

Destination State:

Where your bees will be shipped.

Number of Colonies:

The number of colonies to be shipped to that state.

Days:

The maximum number of days before departure that your inspection may be performed if less than six months.

Special Requirements:

List any special requirements the destination state may have.

Repeat these instructions for each state to which you will ship colonies of bees.

Destination State:

Number of Colonies

Days

Special Requirements

_________________________

Inspection Fees:

Inspection fee is $50.00 per hour plus mileage at the current IRS mileage reimbursement rate. Do not submit payment with this application. You

will be billed after the inspection has been completed.

For Office Use

I hereby certify that the information contained in and submitted with this form is true and correct.

Signature ________________________________ Title __________________________ Date __________

Please Print Name_ _____________________________________________________________________

(Last)

(First)

(MI)

In accordance with the Americans with Disabilities Act, an alternative form of communication is available upon request. TDD: 800 .627.3529

An Equal Opportunity Employer and Pro vider

AG-03007 (08/09)

Form Ag-03007 Apiary Inspection Application - Minnesota Department Of Agriculture

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