Texas Department Of Agriculture Public Weigher Certificate Of Page 2
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4RWM-702 Public Weigher Certificate of Authority Application
Page 2 of 4
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RESPONSIBLE PERSON INSTRUCTIONS
Please list the full legal name (no aliases or nicknames) of the primary person responsible for the business, as
indicated:
For a corporation, limited liability company, or cooperative, the president or CEO,
For a limited or general partnership, the managing partner or general manager,
For a sole proprietorship, the owner,
For any other type of business, the general manager.
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RESPONSIBLE OFFICER, PARTNER, MANAGER, OR OWNER
Last Name
First Name
M. I.
Phone No.
E-mail
(
)
-
Ext.
3
RESPONSIBLE PERSON MAILING ADDRESS
Address
City
State
Zip
Web Address of Business (optional)
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PERSON TO CONTACT FOR LICENSE-RELATED MATTERS
Last Name
First Name
M. I.
Primary Phone
Secondary Phone (optional)
(
)
-
Ext.
(
)
-
Ext.
Fax (optional)
(
)
-
Ext.
E-mail Address
***Important Note*** I understand that my email address is required for the Texas Department of Agriculture to keep me
informed of critical information, including licensing and regulatory updates; renewal invoices; and other important
communications. Failure to provide an email address may result in my not receiving time-sensitive information that could
affect my compliance with state regulations, thereby, resulting in monetary penalties.
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MAILING ADDRESS
Address
City
State
Zip
Licensing Department
Revised 1/1/16
Administrative Services Division
Occupational
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