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

Texas Department Of Agriculture Public Weigher Certificate Of Page 4

RWM-702 Public Weigher Certificate of Authority Application

Page 4 of 4

SIGNATURE

The applicant, by and through their personal or agent's signature below (1) certifies that all information provided in

connection with this application at any time is true and correct to the best of the applicant's knowledge; (2)

acknowledges that any misrepresentation or false statement made by the applicant, or an authorized agent of the

applicant, in connection with this application, whether intentional or not, will constitute grounds for denial,

revocation, or non-renewal of any license issued pursuant to this application and/or assessment of monetary

administrative penalties; and (3) if applying as an individual, further acknowledges that this application may be

denied and that any license issued pursuant to this application may be suspended, revoked, or denied renewal due

to delinquency in payment of a guaranteed student loan and that any license issued pursuant to this application

may be suspended or denied renewal for failure to pay child support. If signed by an agent (including employee) of

the applicant, the person signing certifies that he or she is authorized to make the preceding certifications on behalf

of the applicant.

Applicant Name

Title

Applicant Signature

Date

month day

year

CHECKLIST

Please use this checklist to ensure you are sending all of the necessary information and documents.

Public Weigher Certificate of Authority Application (signed and dated)

Fee ($500)

Bond of Public Weigher in the amount of $10,000 for a duration of 2 years

Please note that an incomplete application may result in processing delays.

Licensing Department

Revised 1/1/16

Administrative Services Division

Occupational

Texas Department Of Agriculture Public Weigher Certificate Of Page 4