Bonded Weighmaster'S License For A Business Or Individual Form (Page 2 of 6) in pdf

Bonded Weighmaster'S License For A Business Or Individual Form Page 2

STATE OF MISSISSIPPI

Department of Agriculture and Commerce

Weights and Measures Division

P. O. Box 1609

Jackson, MS 39215-1609

Lester Spell, Jr., D.V.M., Commissioner

License No. Issued: _________________

APPLICATION FOR BONDED WEIGHMASTER’S LICENSE

FOR A BUSINESS OR INDIVIDUAL

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 or individual who engages in business as a public weighmaster.

BUSINESS SECTION

Full Name of Business

(PLEASE PRINT)

Physical Address (No P. O. Boxes)

Mailing Address

City

State

Zip Code

City

State

Zip Code

Telephone Number

Fax Number

Telephone Number

Fax Number

INDIVIDUAL SECTION

Full Name of Individual

Age

Date of Birth

(PLEASE PRINT)

Mailing Address

City

State

Zip Code

Telephone Number

County

Date Employed

Present Position

Company Represented

Company Physical Address (No P. O. Boxes)

Company Mailing Address

City

State

Zip Code

City

State

Zip Code

Telephone Number

Fax Number

Telephone Number

Fax Number

Is Applicant a resident of the State of Mississippi? □ Yes □ No If no, Where? ____________

Is Applicant a citizen of the United States? □ Yes □ No

If not, has applicant declared intention to become a

citizen of the United States? □ Yes □ No

Does Applicant understand correct weight procedures and how to complete weight certificates? □ Yes □ No

Bonded Weighmaster'S License For A Business Or Individual Form Page 2

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