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Iowa Grain Dealers License - Iowa Department of Agriculture and ...

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If applicant is a partnership the partners are as follows:Name AddressName AddressName AddressLOCATION OF ALL BRANCH OFFICES TO BE OPERATED UNDER THIS LICENSE :Applicant will submit such further evidence in support <strong>of</strong> statements made in the application as required by the <strong>Department</strong> <strong>of</strong> <strong>Agriculture</strong> <strong>and</strong>L<strong>and</strong> Stewardship. As a condition to the granting <strong>of</strong> this application, applicant agrees to comply with <strong>and</strong> abide by all the terms <strong>of</strong> <strong>Iowa</strong> CodeChapters 203 <strong>and</strong> 203D <strong>and</strong> such rules as are, or may be, prescribed thereunder by the <strong>Department</strong> <strong>of</strong> <strong>Agriculture</strong> <strong>and</strong> L<strong>and</strong> Stewardship.Dated this day <strong>of</strong> ,BySignature <strong>and</strong> TitleOATHState <strong>of</strong>County <strong>of</strong>ss.I, being first duly sworn on oath, depose <strong>and</strong> say that I am the<strong>of</strong> , that I have read the foregoing application, know its purpose, amBusiness Namefamiliar with the facts therein set forth <strong>and</strong> the same is true <strong>and</strong> correct.TitleSignatureSubscribed <strong>and</strong> sworn to before me, a Notary Public in <strong>and</strong> for the State <strong>and</strong> County above named, this day <strong>of</strong>, .Notary PublicApplication must be signed <strong>and</strong> sworn to by applicant, if an individual; by a member <strong>of</strong> the partnership, if applicant is a partnership; by a corporate <strong>of</strong>ficerif the applicant is incorporated; or by an authorized manager if the applicant is a limited liability company.009-0598 (09/11)For Office Use Only :n/w c / r f /scsc whse# fyeFees:master gd#Effective :Approved by :

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