Renewal Application For Bonded Weighmasters License For Business Or Individual Form
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2RENEWAL APPLICATION FOR BONDED WEIGHMASTERS
LICENSE FOR BUSINESS OR INDIVIDUAL
No. _____________________
This will certify that information contained in the original application for license filed with the
Mississippi Department of Agriculture and Commerce has not changed in any way since
notarized application was filed.
Full Name of Applicant
Firm Name
Applicant’s Physical Address (No P.O. Boxes)
City
State
Zip Code
County
Telephone Number
Fax
Applicant’s Mailing Address
City
State
Zip Code
County
Policy or Bond #
Expiration Date
Current License Number
_______________________________
_________________________________
Date
Signature of Applicant
________________________________
Title
Enclose with this form:
? License fee of $25.00 for each individual license.
? License fee of $100.00 for Business license.
? $5000 Bond in one of the following forms:
Surety Bond
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Continuation Certificate
Renewal Certificate
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