Form WA-50 Application for License or Modification of License for t

This form is available electronically.

Form Approved – OMB No. 0581-0305

WA-50 (xx-xx-xx)

U.S. DEPARTMENT OF AGRICULTURE Agricultural Marketing Service

APPLICATION FOR LICENSE OR MODIFICATION OF LICENSE FOR THE CONDUCT OF A PUBLIC WAREHOUSE (Under the United States Warehouse Act (7 U.S.C. 241 et seq.))

The SECRETARY OF AGRICULTURE, Washington, D.C. The undersigned warehouse hereby applies for a license or amended license to conduct a public warehouse.

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended).  The authority for requesting the information identified on this form is 7 CFR Part 869, 7 CFR Part 1423, 7 CFR Part 1427, the United States Warehouse Act (Pub. L. 106-472), and the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.). The information will be used to allow warehouse operators to apply for new licensing or changes to existing licensing under the United States Warehouse Act. The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination of ineligibility to obtain new licensing or retain existing licensing under the United States Warehouse Act. 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 0581-0305. The time required to complete this information collection is estimated to average 5 minutes 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. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.  RETURN THIS COMPLETED FORM TO THE WAREHOUSE AND COMMODITY MANAGEMENT DIVISION, STOP 9148, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.

1. Name and Location of Warehouse exactly as printed and/or shown on Warehouse Receipts (City, County or Parish and State)

     

2. Agricultural Products Stored or to be Stored

3. License Number

4. Total Estimated Capacity Under New or Amended License: (Bu., bale, lbs, cwt. or as appropriate)

     

     

     

5. Licensing Action

6. AMENDMENT ACTION

Original Amendment

A. Add new space B. Delete presently licensed space C. Other

D. Amendment Number

E. Estimated Additional Capacity

F. Estimated Deleted Capacity

     

     

     

G. Facilities, Bins, Warehouses being Added or Deleted (Describe briefly:)

     

The agricultural product to be stored and the licensed capacity of the warehouse when stated on the license issued as the result of this application will be as defined and as determined under applicable licensing agreements.

7A. Type of Entity

7B. State Under Whose Laws Created

Individual Partnership Corporation Other Specify:

     

     

APPLICANTS NOT PRESENTLY LICENSED: Consideration of application will be expedited if copies of partnership agreement; certified articles of incorporation; by-laws and foreign corporation permit; articles of organization and operating agreement for an L.L.C. are submitted with application.

8. Applicant’s Interest In Warehouse To be Licensed, (E.G., OWNED, LEASED, ETC.). Consideration of application will be expedited if copies of any leases are submitted with application.

9.

Applicants not presently licensed must submit a current financial statement in accordance with regulations.

10.

The applicant, as a condition to the granting of the license, agrees to comply with and abide by the terms of the Act and regulations as they may relate to the applicant and upon the suspension, revocation or expiration of the license, to deliver all unissued licensed warehouse receipts to the Deputy Administrator or representative thereof. Those receipts will be destroyed by the Department without liability to the warehouse operator one year from the date of suspension, revocation or expiration of the license, if the applicant does not authorize destruction prior thereto.

NOTE: Application should be signed by an officer of the corporation in the case of corporations and all partners in the case of partnerships.

12.

The statements made in this application are certified to be true to the best knowledge and belief of the applicant.

A. Applicant

B. Applicant Email

C. Date of (MM-DD-YYYY)

     

     

     

D. Authorized Signature

E. Title

     

USDA is an equal opportunity provider, employer, and lender.