FTPP-231 Sample License Certificate & Instr.

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICES
FAIR TRADE PRACTICES PROGRAM, PACA DIVISION
NATIONAL LICENSE CENTER
1400 INDEPENDENCE AVE, SW ROOM# 1522
WASHINGTON, DC 20250

LICENSE CERTIFICATE
(Issued Under the Perishable Agricultural
Commodities Act - 7 U.S.C. 499a - 499s)

(800) 495-PACA
1. LICENSE NO.

2. ANNIVERSARY
DATE

3. TYPE OF BUSINESS

4. NATURE OF BUSINESS

BOTH FRESH & FROZEN

BROKER

5. OWNERSHIP TYPE

6. NO. OF
BRANCHES

LIMITED LIABILITY COMPANY

0

Read
"NOTICE TO LICENSEE"
on reverse side
LICENSEE:
Please examine this Certificate
for accuracy.
Report errors to P.A.C.A. Office
at above address

BUS:

Phone:

Fax:

Email:

(

STATE IN WHICH INCORPORATED OR FORMED

EIN:

DATE INCORPORATED

PRINCIPALS -OWNERS, PARTNERS, OFFICERS, DIRECTORS, MEMBERS, AND HOLDERS OF MORE THAN 10% OF STOCK
NAME ( LAST - FIRST - MIDDLE INITIAL )

TITLE

M,MB

FTPP-231

This is to certify that the above is licensed under the Perishable Agricultural Commodities Act, 1930, to handle
fresh and frozen fruits and vegetables as a commission merchant and/or dealer, and/or broker as defined in said
Act until such time as this license is suspended, revoked or terminated.

(05-18)
CG: HFDL
DEPUTY ADMINISTRATOR, FAIR TRADE PRACTICES PROGRAM

NOTICE TO LICENSE
This license covers transactions conducted only by the licensee to whom issued.
Licensees are required to promptly notify the Department of any changes to their license. This
includes change of address, changes to principals, branches and trade names. More than one
trade name may be used by an entity and covered by the same licensee after approval by the
Department of Agriculture.
When there are any changes in ownership of a business, an addition or withdrawal of member of
a partnership, or in case the business is conducted under a different corporate charter, a new
license is required.
Report all changes to:

U.S. Department of Agriculture
Agricultural Marketing Service
Fair Trade Practices Program,
PACA Division National License Center
1400 Independence Ave, SW, Room# 1522
Wasshington, DC 20250

Questions, call (800) 495-7222 or email [email protected]
Visit our website at www.ams.usda.gov/paca

CODES USED ON LICENSE CERTIFICATE
TITLE OF PRINCIPAL
A – Assistant
Ad - Administrator (rix)
C - CoCh - Chairman
Cl - Clerk
Co - Comptroller
D - Director
E - Executive
Ex - Executor (rix)
G - Guardian
Gp - General Partner
I - Individual Owner

Lp - Limited Partner
M - Manager
Mb - Member
P - President
Pa - Partner
R - Receiver
S - Secretary
Sh - Stockholder
Sp - Special or Silent Partner
T - Treasurer
Tr - Trustee
Vp - Vice-President

Executive Order 9397 and 7 USC 499, et. Seq., authorize solicitation of information. Disclosure is
mandatory to evaluate eligibility of license. Failure to provide information may cause delay in processing
the application. Information may be referred to: Department of Justice and other agencies, whether
Federal, State, local or foreign responsible for implementing, or for investigating or processing violations
of the applicable statute, rule regulation or order; to a court, magistrate, or administrative tribunal; or to a
Congressional office in response to constituent's request about his/her records.
FTPP-231 (05-18) Reverse