Beerkeeper Registration Form - Vermont Agency Of Agriculture, Food And Markets (Page 4 of 8) in pdf

Beerkeeper Registration Form - Vermont Agency Of Agriculture, Food And Markets Page 4

Business Office/L&R

116 State Street  Montpelier, Vermont 05620-2901  (802) 828-2436  (802) 828-3831 FAX

Total # Apiaries: _

Total # Colonies:

Date:

_______________

Signature:

Read and initial following statement and sign application. The application will be returned if all areas

are not initialed or signed.

Please Initial:

I hereby certify that I am in good standing with respect to any obligations for child support

and, 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 to the state of Vermont as of the date

of this application.

Please sign and remit payment of $10.00 per apiary location to:

Vermont Agency of Agriculture, Food & Markets

Business Office L&R

116 State Street

Montpelier, VT 05620-2901

(802) 828-2436

****TURN OVER AND COMPLETE BOTH SIDES***

The State of Vermont is an Equal Opportunity / Affirmative Action Employer and Provider

Beerkeeper Registration Form - Vermont Agency Of Agriculture, Food And Markets Page 4