Texas Department Of Agriculture Public Weigher Certificate Of (Page 3 of 4) in pdf

Texas Department Of Agriculture Public Weigher Certificate Of Page 3

RWM-702 Public Weigher Certificate of Authority Application

Page 3 of 4

FACILITY INFORMATION – NAME OF LICENSEE

Facility Name

PHYSICAL ADDRESS OF LOCATION (WHERE WEIGHING WILL TAKE PLACE)

Address (No P.O. Box)

City

State

Zip

County

Directions to Physical Location if address above is difficult to find

OUT-OF-STATE APPLICANTS ONLY

An applicant for a Public Weigher license whose principal place of business is situated outside the State of Texas

must appoint and designate a resident citizen of Texas as said applicant’s resident agent within Texas. If address

provided in Section B is out of state resident agent information is REQUIRED.

Who do you wish to designate as resident agent?

The Texas Secretary of State

Other (list below)

Resident Agent Name

Resident Agent Address

City

Zip

Business Phone

(

)

PUBLIC WEIGHER FEE

Public Weigher – ($500 fee) – Proceed to Section G

PAYMENT

REGISTRATION IS NOT VALID UNTIL APPROVED BY TDA.

Method of Payment (payable to Texas Department of Agriculture)

Cashier’s Check #

Check #

Money Order #

Amount remitted

Mail to: Texas Department of Agriculture

P.O. Box 12076, Austin, TX 78711-2076

TDA USE ONLY

Receipt No.

Date Receipt Issued

Licensing Department

Revised 1/1/16

Administrative Services Division

Occupational

Texas Department Of Agriculture Public Weigher Certificate Of Page 3