Application For Bonded Weighmasters License (Business) Form
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2STATE OF MISSISSIPPI
Department of Agriculture and Commerce
Lester Spell, Jr., D.V.M., Commissioner
WEIGHTS AND MEASURES DIVISION
P.O. Box 1609
Jackson, MS 39215-1609
No. _________________
APPLICATION FOR BONDED WEIGHMASTERS LICENSE
(BUSINESS)
The undersigned hereby applies for a license to engage in business as a Bonded Weighmaster, as defined by
Section 75-27-303(1) Mississippi Code of 1972, as amended, such license being required by Section 75-27-
307(1) for any business who engages in business as a public weighmaster.
Full Name of Applicant
Give Firm Name: If corporation or partnership, give exact title
Physical Address
City
State
Zip Code
Telephone Number
Mailing Address
City
State
Zip Code
Fax Number
Is the business of the applicant owned by (a) individual, (b) partnership, (c) a corporation, or (d) a cooperative:
State business or trade names used, if any ________________________________________________________
____________________________________ where filed ___________________________________________
If partnership:
NAME OF ALL PARTNERS
ADDRESS
AGES
If corporation: In what state incorporated ________________________ Date incorporation ________________
OFFICERS
NAME
ADDRESS
President
Vice-President
Secretary
Treasurer
Chief Exec. Officer
Principal office if State of Mississippi ___________________________________________________________
Is Applicant a subsidiary of or affiliated in any way with any other corporation __________________________
Domestic __________________________
Foreign _________________________________________
(Continued on Back)
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