Application to Operate an Establishment Under the Iowa Meat Inspection Act

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___________________________________________________________________________________________________________

Iowa Department of Agriculture

and Land Stewardship

Wallace Building

Des Moines, Iowa 50319

This notice is to inform you that in accordance with Chapter 189A, Code of Iowa, “No person shall operate an establishment without

first obtaining a license from the department except as exempted by the Meat and Poultry Inspection Act.”

$25.00 Establishments at which meat and poultry is slaughtered or otherwise prepared not exceeding twenty thousand pounds

per year for sale, resale, or custom, the license fee is twenty-five dollars.

$50.00 Establishments at which meat and poultry is slaughtered or otherwise prepared in excess of twenty thousand pounds

per year for sale, resale or custom, the license fee is fifty dollars.

The State of Iowa reserves the right to approve, accept, disapprove or reject this instrument for a reasonable period of time and

attaches no legal rights or obligation to the immediate processing of your remittance.

“This is an equal opportunity program. If you believe you have been discriminated against because of race, color, national origin, age,

sex, religion or handicap, write immediately to the Secretary of Agriculture, or Administrator, FSIS, Washington, D.C. 20250.”

(Detach here and mail application only)

APPLICATION FOR A LICENSE TO OPERATE AN ESTABLISHMENT UNDER

THE IOWA MEAT INSPECTION ACT

SECRETARY OF AGRICULTURE, Des Moines, Iowa 50319 Date of this application _______________________

I hereby make application for Meat and Poultry Inspection license for the period ending June 30, ____________________________

I enclose license fee: __________________ Last License number _______________________________

Phone No. ______________________________________

Name of Business ____________________________________________________________________________________________

Owner’s Name _____________________________________________________________________________________________

Business Address ___________________________________________________________________________________________

City __________________________________ Zip ___________________ If seasonal, give opening date ___________________

County ______________________________ Ownership changed since last license issued? Yes __________ No ___________

If yes, give previous owner and business name _____________________________________________________________________

If you have changed location of business since receiving last license, give address:

Any change in location, address, ownership or partnership requires a new license. LICENSES ARE NOT TRANSFERABLE OR

REFUNDABLE. Currency sent at owner’s risk. Make checks payable to IOWA DEPARTMENT OF AGRICULTURE AND LAND

STEWARDSHIP.

_____________________________________________________ (Signature of applicant)

Mailing address for all correspondence if different than above:

Name _____________________________________________________________________________________________________

Street or Route ______________________________________________________________________________________________

City _____________________________________________ State _________________________ Zip ___________________