Application for Certificate of Registration

NICOLE "NIKKI" FRIED COMMISSIONER

Florida Department of Agricultural and Consumer Services

Division of Plant Industry

Remit online payment at

APPLICATION FOR CERTIFICATE OF REGISTRATION

Or

Check or Money order payable

to:

Section 581.131, F.S. / Incorporated in Rule 5B-2.0011, F.A.C. Referenced in Rules 5B-2.002 and 5B-62.007(2) (a), F.A.C.

Phone (352) 395-4700

FDACS P.O. Box 6720 Tallahassee, FL 32314-6720

PLEASE PRINT ALL INFORMATION

Firm Name: Date: Owner: Address (Mailing): Physical Location: Email Address:

Fee Due: $

Telephone: Fax:

CHECK ONE: [ ] CERTIFICATE OF NURSERY REGISTRATION

The above nursery has been inspected by an authorized representative of the Division of Plant Industry. A Certificate of Nursery Registration is required for propagation, sale or distribution of plants.

Nursery stock produced for sale or distribution, including own-use nurseries. Governmental agency whose nursery stock is used exclusively for planting on government property.

[ ] CERTIFICATE OF STOCK DEALER REGISTRATION

The above listed firm hereby makes application for a Certificate of Stock Dealer Registration by completing and

signing this agreement and by remitting a fee of $25.00 per location or $69.00 per location if the inventory is 5000 or

more plants (see Rule 5B-2.002(2)(c), F.A.C.) A Certificate of Stock Dealer Registration is required for any person

purchasing certified nursery stock for resale.

Number of locations at $25.00

Will your business be selling citrus plants?

Number of locations at $69.00

(yes or no)

(Furnish a complete address and telephone number for each location)

APPLICANT AGREES TO: 1. Deal only in nursery stock that has been inspected and approved by the Division of Plant Industry (or imported in

compliance with Florida laws) and accompanied by a valid inspection certificate (tag) as required by Chapter 581, Florida Statutes. 2. Not knowingly sell or distribute nursery stock to individuals intending to resell or further distribute such stock within the State of Florida unless such individuals are registered with the Department as a nursery or nursery stock dealer. 3. Not knowingly sell or distribute nursery stock for planting within 100 feet of a commercial citrus grove, a citrus nursery, or an approved nursery site, unless the stock is burrowing nematode-certified. 4. Not bring or cause to be brought into the state any citrus plants or parts of citrus plants without a valid permit from the Director of the Division of Plant Industry. 5. Furnish a list of all plant movements with full name and address of all purchases and consignees with a complete description of the stock in each movement, when requested. 6. When requested to do so, return all inspection certificates (tags) on hand, including rubber stamps, to the Division of Plant Industry. 7. Permit the entry of authorized representative of the Department for the purpose of inspecting plants or plant products for plant pests or noxious weeds.

Signed: _______________________________________________

Title: _________________________________________________

DPS # _______________

COUNTY ________________

RISK FACTOR ___________

ROUTE NUMBER _________

Org Code: 42080701000

EO: A8

Nursery Object Code: 001062

Stock Dealer Object Code: 001094

FDACS-08004 REV. 11/15

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