Fill Out Your Tennessee Pesticides Form Modify Form Now

Fill Out Your Tennessee Pesticides Form

The Tennessee Pesticides form is an essential application used to register pesticides for sale or distribution within the state. This form must be filed with the Commissioner of Agriculture and includes necessary documentation and fees. To ensure compliance, it is crucial to fill out this form accurately and submit it on time; click the button below to get started.

Modify Form Now
Table of Contents

The Tennessee Pesticides form is a crucial document for businesses seeking to register pesticide products for sale or distribution within the state. This application must be filed with the Commissioner of Agriculture and includes essential details about the product, such as its brand name and EPA registration number. Each registration is valid until June 30 of the following year, requiring an annual fee of $100 for each product. If applications are submitted after the July 31 deadline, a late fee of $50 is incurred for each renewed or discontinued product. The form also necessitates the inclusion of both the registrant's and the correspondence firm's details, ensuring that the correct entities are identified for communication regarding the registration process. Applicants must certify the accuracy of the information provided, and the form allows for additional sheets if necessary. For those who wish to receive confirmation of their registration, a duplicate submission is recommended. Proper completion of this form is vital for compliance with state regulations and for the successful registration of pesticide products in Tennessee.

Tennessee Pesticides Sample

APPLICATION FOR THE REGISTRATION OF PESTICIDES IN TENNESSEE

This application is hereby filed with the Commissioner of Agriculture. The product(s) listed on the back are offered for sale or distribution within Tennessee and all fees and any required doucmentation are included. This registration shall be effective until June 30 of each year.

This fee is $100.00 for each product with a $50.00 late fee per renewed or discontinued product for applications received after July 31.

Enclosed is the annual registration fee of $_______________ for _______________ products.

Make your check payable to: TENNESSEE DEPARTMENT OF AGRICULTURE and send it to:TENNESSEE DEPARTMENT OF AGRICULTURE, Division of Consumer and Industry Services, P.O. Box 40627, Nashville, TN 37204, Attention: Pesticide Registration

REGISTRANT:

Firm: ___________________________________________

Address:___________________________________________

___________________________________________

Phone: ___________________________________________

Contact:___________________________________________

This should be the name and address of the company on the pesticide label.

Do not list by any other name on this section.

SEND CORRESPONDANCE TO:

Firm: _________________________________________

Address: _________________________________________

__________________________________________

Phone: __________________________________________

Contact:__________________________________________

This should be the company that will handle the registration for the above (e.g. parent firm, manufacturer, etc.).

If it is the same as the above, please list again.

I certify to the best of my knowledge that this application is true and accurate:

Signature and Date:_______________________________________________

DEPARTMENT USE ONLY

DATE OF APPROVAL:_________________________ STATE REGISTRANT NUMBER: _________________________

APPROVED:____________________________________________________

PESTICIDES TO BE REGISTERED IN TENNESSEE

Submit a duplicate if you wish to receive a copy from the Department verifying your registration. Please refer to the

cover sheet for instructions. Attach additional sheets if necessary.

EPA Registration Number:

Brand Name of Product (Please note if it is "RUP")

Document Details

Fact Name Details
Governing Law The application is governed by Tennessee state law regarding pesticide registration.
Application Purpose This form is used to register pesticides for sale or distribution within Tennessee.
Registration Validity The registration remains effective until June 30 of each year.
Registration Fee The fee for registration is $100.00 for each product.
Late Fee A late fee of $50.00 applies for applications received after July 31.
Payment Instructions Checks should be made payable to the Tennessee Department of Agriculture.
Contact Information Registrant must provide the name and address of the company on the pesticide label.
Certification Requirement The applicant must certify that the information provided is true and accurate.
Please rate Fill Out Your Tennessee Pesticides Form Form
4.68
(Stellar)
22 Votes

More PDF Forms