Application For Registration And License Under The Meat, Meat-Food And Poultry Regulation And Inspection Act Of 1960 - Mississippi Department Of Agriculture And Commerce

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MISSISSIPPI DEPARTMENT OF AGRICULTURE AND COMMERCE
Meat Inspection Division, P.O. Box 1609, Jackson, MS 39215-1609
(601) 359-1191 FAX (601) 359-1105
APPLICATION for REGISTRATION and LICENSE under the MEAT, MEAT-FOOD, and
POULTRY REGULATION and INSPECTION ACT of 1960
1.
Name and Address
2.
County
P.O. Address
Telephone
Name and Address of Owner(s)
3.
Telephone
4.
Name of Operator or Manager
5.
Name of Lessor or Lessee
Address
Telephone
6.
Subsidiaries operating in the establishment
7.
Location of any establishments and facilities used in connection with this business
8.
Do you desire product inspection?
(Full-time)
(Part-time)
9.
When did this business begin operation?
Has license or permit of this establishment ever been refused, revoked or suspended?
Yes
No
10.
Describe completely and concisely the business carried on
11.
List finished products
12.
Estimated number of animals slaughtered (or pounds processed) weekly:
Cattle
Swine
Poultry
Goats
Sheep
Rabbits
Other
ATTACH BLUEPRINTS OR DRAWING TO SCALE OF ESTABLISHMENT, AND A PLOT PLAN
ENCLOSE RECENT PHOTOGRAPH OF BUILDING--IF AVAILABLE.
ENCLOSE FEE OF $10.00 (please do not mail cash).
I, the undersigned, do hereby state on oath that the facts set forth in the foregoing application are true and
correct.
Signature
Sworn to and subscribed before me on this
day of
,
Notary Public
SEAL
EQUAL OPPORTUNITY IN EMPLOYMENT AND SERVICES

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