P&SP 1000 Application for Registration

Instructions To Complete
Application For Registration
Form P&SP – 1000
Form P&SP-1000 is used by applicants to register their operation with the Packers and Stockyards Program as a
dealer buying and selling livestock for their own account or for the account of others, a market agency buying
livestock on a commission basis, or a market agency selling livestock on commission. If any information is missing
or incorrect, the Packers and Stockyards Program will return the application form to the principal for completion or
correction.
Operating without proper registration and bond may subject the principal to penalties under law, including a fine of
not more than $550 for each violation and not more than $27.50 for each day it continues.
Mail the completed form to the regional office of the Packers and Stockyards Program as listed below. The states
covered by each regional office are listed below the regional office’s address.
Regional Offices of the Packers and Stockyards Program
Grain Inspection, Packers and Stockyards Administration
Eastern Regional Office
Western Regional Office
Midwestern Regional Office
Suite 230
3950 Lewiston St., Suite 200
Room 317
75 Spring Street
Aurora, CO 80011-1556
210 Walnut Street
Atlanta, GA 30303-3308
Telephone: (303) 375-4240
Des Moines, IA 50309-2110
Telephone: (404) 562-5840
FAX: (303) 371-4609
Telephone: (515) 323-2579
FAX: (404) 562-5848
E-mail:
FAX: (515) 323-2590
E-mail:
[email protected] E-mail:
[email protected]
[email protected]
States Covered
States Covered
States Covered
AL, AR, CT, DC, DE, FL, GA, LA, AK, AZ, CA, CO, HI, ID, KS, MT, IA, IL, IN, KY, OH, MI, MO, MN,
MA, MD, ME, MS, NC, NH, NJ,
NM, NV, OK, OR, TX, UT, WA,
ND, NE, SD, WI
NY, PA, RI, SC, TN, VA, VT, WV
WY
If you have any questions about the form or completing the form, please contact the appropriate regional office of
the Packers and Stockyards Program as listed above.
Applicants must complete lines 1 through 19 and 21 and sign line 20.
If any information for lines 15 and 16 does not fit into the space provided, attach a separate sheet of paper with the
information.
Line No.
1

2

3a
through
3f
4a
through
4f

P&SP-1000-I

Subject
Name of Applicant to be
Registered

Trade Name or Alias

Mailing Address

Operating Address

Instruction
If you will operate as an individual, enter your first name, middle
initial, and last name. If you will operate as a partnership, enter each
partner’s first name, middle initial and last name. If you will operate
as a corporation, association, Limited Liability Partnership (L.L.P.),
or Limited Liability Corporation (L.L.C.), enter the name of the
corporation, association, L.L.P., or L.L.C.
Enter the trade name under which you, the applicant will operate.
This is the name the business will use. If you do not operate with a
“Trade Name” or an “Alias,” enter “N/A.”
Enter your mailing address. Enter street, city, county, state, zip +4
code, and country. This is the address where all correspondence
from the Packers and Stockyards Program will be sent.
Enter the physical location of your operating address. Enter street,
city, county, state, zip +4 code, and country. This is the address
where you conduct your business services.

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Line No.
5

Subject
Telephone No.

6
through
8
9

Cell Phone No., Fax No.,
and E-Mail Address

10

Web Site Address (if
applicable)
Type of Livestock Handled

11
a and b

Character of Business –
Market Agency/Dealer

11c

Character of Business Clearee
Character of Business Cleared by

11d

12a
through
12c

Type of Organization

13a
through
13d

Owners, Partners, Or
Officers, (Name and Title)
Percent Ownership
Mailing Address (Number
Street, City, State, Zip Code)

14

Names and Location of
Posted Stockyards, Auction
Markets, Feedlots, and Web
Sites Where Applicant Will
Operate

15

If Previously Registered,
Registered Name and
Address

16

Does the Registrant Own or
Lease a Scale Used in the
Purchase and Sale of
Livestock?
Registrant Will Operate On

17

P&SP-1000-I

Instruction
Enter the telephone number, including area code, where you may be
reached during the hours of 8:00 a.m. to 5:00 p.m. local time.
Enter the business’ e-mail address, if applicable, fax number, and
cell phone number.
If you operate a web site in conjunction with your livestock
operations, enter the complete Web site address the business
operates. For example: www.WebSiteName.com
Check the appropriate box to indicate each type of livestock the
business will be handling.
Check each type of operation that applies to the business. If you are
completing the application as a stockyard owner, check the box for
Other and specify “stockyard owner” and the name of the stockyard.
If you are providing your own bonding instrument, please check the
no box or leave 11c blank.
If you are named as a Clearee on another registrant’s bonding
instrument, check the yes box and enter the registrant’s name
providing the bond coverage.
Check the appropriate box to indicate the type of organization as it
applies to the business’ operation. If appropriate, enter the state
where the organization was formed, and the date the organization
was formed.
For each owner and every partner, enter their name, title, and
respective percentage of ownership. Provide this information for
every individual with any ownership interest in the applicant’s
operation.
For every officer, enter their name, and title.
IF APPLYING TO OPERATE AS A DEALER OR MARKET
AGENCY, BUYING ON COMMISSION:
Enter “In Commerce” or, if desired, enter the stockyards and
markets (including city and state) where you will conduct business.
IF APPLYING TO OPERATE AS A MARKET AGENCY
SELLING ON COMMISSION:
Enter the address of the auction market, including city and state,
where you will conduct business.
IF OPERATING AT A WEB SITE:
Enter the web site(s), other than your own, where you will be
purchasing or selling livestock.
If you or your business was previously registered with the Packers
and Stockyards Program, enter the name(s) under which your or
your business was previously registered, and the street, city, state,
and 9-digit zip code(s) of the prior business(es).
Check the appropriate box to indicate if the registrant owns or leases
a scale used in the purchase and sale of livestock. If yes, enter the
location (address, city, state, and zip +4 code), model, and serial
number of each scale.
Every registrant is required to file an annual report on a prescribed
form. Check the appropriate box to indicate whether the business is
operating/filing on a calendar year or fiscal year basis. If
operating/filing on a fiscal year basis, enter the beginning and
ending dates of the business’ fiscal year (for example, November 1
to October 31)

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Line No.
18

Instruction
If the applicant intends to operate as an auction market, check the
appropriate box to indicate all of the days the market will conduct
regular sales. Special sales need not be included on the application
form.
19a
Market Agency Selling on
Every market agency selling on commission is required to establish
through
Commission - Custodial
and maintain a separate bank account designated Custodial Account
19h
Account Number
for Shippers’ Proceeds.
For the bank where this account has been established, enter the
name, the number of the account at the bank, address, telephone
number, and the name of a contact person. More information about
this account is available from the regional offices of the Packers and
Stockyards Program included above.
CERTIFICATION
The applicant must certify that its current assets exceed its current liabilities (and therefore, meets the financial
requirements of the Packers and Stockyards Act).
20
Signature and Title
The applicant must sign the application if operating as an individual.
(Owner, Partner, Or
If the applicant is a partnership, the signature must be that of a
Responsible Officer)
partner.
If the applicant is a corporation, association, L.L.C., or L.L.P., the
signature must be that of an owner or officer.

21

P&SP-1000-I

Subject
Sale Days (If applicable)

Date

Enter the title of the person signing the application.
Enter the date the application is signed by the applicant.

Page 3 of 3

OMB Control No. 0580-0015
Expires: xx/xx/20xx
U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
PACKERS AND STOCKYARDS PROGRAM

APPLICATION FOR REGISTRATION
(Under Packers and Stockyards Act, 1921, as Amended and Supplemented)

1. Name of Applicant to Be Registered (Individual or Firm)
2. Trade Name or All Known Aliases
3a. Mailing Address
3b. City

3d. State

3c. County

3e. Zip

3f. Country

4a. Operating Address
4b. City

4d. State

4c. County

4e. Zip

4f. Country

5. Telephone No.

6. Cell Phone No.

7. Fax No.

8. E-Mail Address
9. Web Site Address
10. Type of Livestock Handled (Check All That Apply):
‰ Cattle
‰ Swine
‰ Sheep and Goats
‰ Horses and Mules
11. Character of Business (Check Applicable Operations):
‰ Selling on Commission
a. Market Agency: ‰ Buying on Commission
‰ Other (Specify)
‰ Clearing Service
‰ Buying and Selling
b. Dealer:
c. Clearee:
‰ Yes
‰ No
d. Cleared By:___________________________________________
12a. Type of Organization (Check One)
‰ Association
‰ Corporation
‰ Individual
12b. State Formed
13a. Owners, Partners,
Members, or Officers
(Name and Title)

Form P&SP-1000

‰ L.L.C.
‰ L.L.P.
‰ Partnership

‰ Other (Specify)

12c. Date Formed
13b. %
Ownership

13d. Home Mailing Address
(Number, Street, City, State, Zip Code)

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14. Names and Locations of Posted Stockyards, Auction Markets, Feedlots, and Web Sites Where Applicant Will
Operate

15. If Previously Registered, List All Registered Names and Addresses

16. Does Registrant Own/Lease a Scale(s) Used in the Purchase and Sale of
Livestock?
‰ No
‰ Yes (Give Physical Location of Scale(s); Street,
City, State, Zip Code, Model, and Serial Number)
17. Registrant Will Operate on
‰ Fiscal Year Basis: _____________ to _____________
‰ Calendar Year
18. If Applicable, Sale Day(s)
‰ Sun
‰ Mon
19a. Bank

‰ Tue

‰ Wed

‰ Thu

‰ Fri

‰ Sat

Market Agency Selling on Commission – Custodial Account Information
19b. Account No.

19c. Street

19d. City

19e. State

19g. Telephone

19f. Zip

19h. Contact Person

CERTIFICATION I certify that the financial condition of the applicant meets the requirements of the Packers And
Stockyards Act, 1921, as amended and supplemented and the application for registration has been prepared by me or
under my direction and that to the best of my knowledge and belief this application is true and correct.
20. Signature and Title (Owner, Partner, or Responsible Officer)
21. Date

Space Below: Not to Be Filled In By the Applicant
Registration Number
Type of Registration
‰ SUPPLEMENTAL
Registered As
‰ MARKET AGENCY

Date of Acceptance

‰ REACTIVATED
‰ DEALER

‰ NEW

‰ AMENDED

‰ MARKET AGENCY & DEALER

‰ RENEWAL
‰ BRAND INSPECTION

Registration is required in order to operate as a market agency or dealer subject to the Packers and Stockyards Act, 1921, as amended and
supplemented and 9 CFR 201.10 (a). Information held confidential (9 CFR 201.96).
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0580-0015. The time required to complete this
information collection is estimated to average 1 hour 30 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering
andthe data needed, and completing and reviewing the collection of information.
maintaining
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital
status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance
program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape,
etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence
Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Form P&SP-1000

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