Application For License To Test And Repair Scales (Service-Repair Company) Form Page 2
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1
2If yes, explain nature of same fully
How long has applicant been engaged in business for which application is made
Applicant understands and affirms that (1) all scale installation and service repairmen representing applicant shall hold the required
Mississippi license(s). (2) all scale service repairmen employed by applicant to perform scale service-repair work in the State of
Mississippi shall be of good moral character, posses the necessary equipment and be sufficiently trained and competent to perform
each and every installation and service-repair task to which such repairman is assigned. (3) all scale installation and service repairmen
shall have access at all times to a current edition of NIST Handbook 44, the Mississippi Weights and Measures Law and applicable
regulations. (4) applicant is responsible for all work performed by and actions and conduct of its employees. (5) applicant shall
supply for use or permit to be used by any scale service repairman employee for scale service repair work in the State of Mississippi
only weights calibrated by an official laboratory with standards traceable to NIST and for which a current certificate of calibration has
been issued by such laboratory. (6) no brass or fabricated (such as a laminated weight or a weight of non-uniform density) weight(s)
may be used by scale service repair companies or scale service repairmen in the State of Mississippi.
This the
day of
,
.
_________________________________
Full Name of Applicant
_________________________________
Firm Name
_________________________________
By
_________________________________
Title
NOTE: (1) Application must be signed. If partnership, each partner must sign. If corporation, corporate name must be
signed in full with the officer’s name or name of agent authorized to sign the application and title on lines below.
(2) Corporate seal must be impressed.
State of
County of
This day personally came and appeared before me, the undersigned authority in and for the jurisdiction
aforesaid,
who, being by me first duly sworn, states on oath that the
matters and things in the foregoing instruments are true and correct as herein stated.
_____________________________
Affiant
Sworn to and subscribed before me on this the
day of ________________________,
________.
_____________________________
Notary Public
My commission expires
NOTE: THE FOLLOWING MUST BE ATTACHED TO THIS APPLICATION:
1.
A listing of the names and addresses of all scale service repairmen employed by applicant.
2.
A copy of certificate(s) of calibration on all weights used by applicant or persons employed by applicants for scale
service repair work in the State of Mississippi.
3.
A check or money order for $100.00 made payable to the Mississippi Department of Agriculture and Commerce
covering the required license fee.
(Office Use Only)
Do Not Write Below
Check Number __________________________
(Date Received)
Amount Received ________________________
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