APHIS 7003 Application for License - Renewal

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 0579-0036. The time required to complete this
information collection is estimated to average .25 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.

OMB APPROVED
0579-0036
Exp.: XX/XXX

No license may be issued unless a completed application has been received (7 U.S.C. 2132-2143), and the applicant is in compliance with the standards and regulations
Section 2133.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

DO NOT USE THIS SPACE- OFFICIAL USE ONLY
SEND THE COMPLETED FORM TO:

APPLICATION FOR LICENSE
(TYPE OR PRINT)
LICENSE NUMBER

RENEWAL DATE
AMOUNT

FEES
DATE RECEIVED

RENEWAL
1. NAME (S) OF APPLICANT(S) AND MAILING ADDRESS:

2. ALL BUSINESS NAMES, LOCATIONS, AND SITES HOUSING ANIMALS:
(P.O. Box not acceptable)

COUNTY:
TELEPHONE:
3. IF THE APPLICANT IS A CORPORATION, PARTNERSHIP, OR OTHER BUSINESS

COUNTY:

TELEPHONE:

4. (A) PREVIOUS USDA LICENSE NUMBER: (If any)

ENTITY, LIST THE ENTITY’S PARTNERS OR OFFICERS AND AGENT FOR SERVICE
OF PROCESS.

NAME

(B) ACTIVE USDA LICENSE NUMBER IN WHICH YOU HAVE AN INTEREST:

TITLE

5. TYPE OF LICENSE:
Class A – Breeder
6. LIST YOUR 12 MONTH BUSINESS YEAR: (Calendar or Fiscal)
MO

FROM
DAY

YEAR

Class C – Exhibitor

7. TYPE OF ORGANIZATION:

TO
DAY

MO

Class B – Dealer

Individual

YEAR

Corporation

Partnership

Other (University, State, Municipality, LLC, Trust) ________________________
8. APPLICANTS FOR CLASS A OR CLASS B LICENSES MUST COMPLETE
THIS BLOCK. (Applicants for Class C Licenses go to Block 9)

DOGS

NON-HUMAN
PRIMATES

RODENTS
(Do not include
lab rats or mice)

ESTIMATE TOTAL NUMBER OF ANIMALS
TO BE PURCHASED IN THE NEXT
BUSINESS YEAR

CATS

MARINE
MAMMALS

WILD/EXOTIC
HOOFSTOCK

ESTIMATE TOTAL NUMBER OF ANIMALS
TO BE SOLD IN THE NEXT BUSINESS
YEAR

GUINEA PIGS

FARM ANIMALS

BEARS

CLASS A (BREEDER) – LINE “D” = ½ OF LINE “C”
CLASS B (DEALER) – LINE “D” = LINE C LESS THE PURCHASE COST OF
THE SOLD ANIMAL SOLD. (9 CFR Sections 2.6 and 2.7)

A.

B.

C.

D.

9. LIST THE LARGEST NUMBER OF ANIMALS THAT YOU HAVE HELD, OWNED, LEASED, OR
EXHIBITED AT ANY ONE TIME DURING THE PREVIOUS BUSINESS YEAR.
(9 CFR Sections 2.6 and 2.7)

ESTIMATE GROSS DOLLAR AMOUNT
DERIVED FROM REGULATED ACTIVITIES
(SALES, COMMISSIONS, ETC.)

$

HAMSTERS

WILD/EXOTIC
CANINES

WILD/EXOTIC
MAMMALS
(Not listed
elsewhere)

ESTIMATE DOLLAR AMOUNT ON WHICH
FEE IS BASED

$

RABBITS

WILD/EXOTIC
FELINES

TOTAL
(All animals listed
in Block 9)

CERTIFICATION
I hereby make application for a license under the Animal Welfare Act 7 U.S.C. 2131 et seq. I certify that the information provided herein is true and correct to the best of my knowledge. I hereby
acknowledge receipt of and agree to comply with all the regulations and standards in 9 CFR, Subpart A, Parts 1, 2, and 3. I certify that the applicant is 18 years of age or older.

10. SIGNATURE:

13. DATE:

11. PRINT NAME AND TITLE:

APHIS FORM 7003
JAN 2010

(Previous editions are obsolete)