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Vermont Ginseng Dealer'S Permit Application Form - Agency Of Agriculture, Food And Markets

STATE OF VERMONT

Agency of Agriculture, Food & Markets, Business Office/ L&R

116 State Street, Montpelier, VT 05620-2901

(802) 828-2436

VERMONT GINSENG DEALER’S PERMIT APPLICATION

Business Name ___________________________________________________________________________

Applicant or Individual’s Name_______________________________________________________________

Mailing Address __________________________________________________________________________

________________________________________________________________________________________

Business Location _________________________________________________________________________

Telephone # _______________________________ E-mail address ________________________________

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I do hereby request a Ginseng Dealer’s Permit as defined by 6 V.S.A. Chapter 206 and Regulations for the

Collection, Cultivation and Sale of American Ginseng.

I will maintain such records as described by regulation and make them available on a quarterly basis (March

31, June 31, September 31 and December 31) to the Secretary of Agriculture or his duly appointed

representative.

_______________________

_________________________________________________

Date

Signature

By law (32 V.S.A. Section 3113) no agency of the State may renew a license or other authority to conduct a

trade or business (including a license to practice a profession) unless the licensee first certifies that he or she is

in good standing with the Department of Taxes. A person is in good standing if no taxes are due, if the

liability for any tax that may be due is on appeal, if the taxpayer is in compliance with a payment plan

approved by the Commissioner of Taxes, or if the licensing authority determines that immediate payment of

taxes due and payable would pose an unreasonable hardship.

The maximum penalty for perjury is fifteen (15) years in prison, a $10,000 fine or both.

CERTIFICATION OF COMPLIANCE WITH 32 V.S.A. SECTION 3113

I herby certify, under the pains and penalties of perjury, that I am in good standing with respect to, or in full

compliance with a plan approved by the Commissioner of Taxes to pay, any and all taxes due the State of

Vermont as of the date of this application.

_______________________

________________________________________________

Date

Signature

Revised 3/08

For Office Use Only

Permit # __________

Expiration Year __________

Date processed ______________

Vermont Ginseng Dealer'S Permit Application Form - Agency Of Agriculture, Food And Markets