Structure
The Pi 017S form, issued by the Michigan Department of Agriculture, serves as a critical document for those engaged in the nursery stock industry. This form is primarily used for applying for a Nursery Stock Dealer and Grower License, which is essential for businesses involved in the sale and cultivation of nursery stock within the state. Applicants must indicate whether they are seeking a new license, renewing an existing one, or no longer require the license. The form collects vital business information, including the name, address, and contact details of the establishment, as well as the type of ownership, which can range from sole proprietorships to corporations. Furthermore, applicants must provide information about the business's leadership, including the owner or president's name and contact details. The form also outlines the associated fees, which are non-refundable and vary depending on the type of license sought, such as a general nursery stock grower or a nursery stock dealer. Payment methods are specified, with instructions for submitting the form and fees to the appropriate address. By completing this form accurately, businesses can ensure compliance with Michigan's licensing requirements, thereby facilitating their operations in the horticultural sector.
Form Example
Michigan Department of Agriculture
P.O. Box 30746, Lansing, MI
In accordance with 1931 Public Act 189, as amended.
Nursery Stock Dealer & Grower License Application
License Year Ending: _______Status: |
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New |
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Renewal |
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No Longer Needed |
If Renewal, License No. of Establisment _______________________________________
Business Information
Business Name:__________________________________________________________
Business Address:________________________________________________________
City:________________________________________________ State: _______________
County:______________________________________________ Zip:_______________
Business Phone: (_____)_____________ Business Fax:(_____)____________________
Business Email:__________________________________________________________
Mailing address if different from above: Street or P.O. Box:___________________________
__________________________________________________________________________
______________________________
Corporate/Owner Information
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Ownership Type: |
Corporation |
Sole Ownership |
Partnership |
L.L.C. |
Other: Specify_____________________ |
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Corporation Name: _______________________________________________________________________________________ |
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Owner/President (CEO) Name:______________________________________________________________________________ |
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Street Address of Corporation or Owner:_______________________________________________________________________ |
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City:______________________________________________________________________ State: _______ Zip:_____________ |
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Phone: (_____)_____________ Fax:(_____)_______________ Email:_______________________________________________ |
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Cell Phone: (_____)_____________ DBA Expiration Date: ____________________________ |
Federal/Tax ID # |
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(Submit copy of DBA w/ application.) |
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License Fees |
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Grower License |
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AOBJ: 0185 |
Dealer License |
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AOBJ: 0342 |
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General Nursery Stock Grower $100 |
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Nursery Stock Dealer $100 |
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Inspection Required |
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Nursery Stock Dealer Market $100 |
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Small Scale Grower* $40 |
Small Scale Grower Market* $40 |
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*eligibility determined by MDA |
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Both $40 fees: AOBJ: 0341
Payment Method: Check/Money Order No. _________________________________________ Amount enclosed: _______________
Please make check/money order payable to the State of Michigan and submit to the address at the top of the page.
Signature:__________________________________________________ Date:___________________
Please print your name here:___________________________________________________________
Title:______________________________________________________________________________
Document Specs
| Fact Name | Details |
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| Governing Law | This form is governed by the 1931 Public Act 189, as amended. |
| License Types | Applicants can apply for either a Nursery Stock Dealer License or a Grower License, each with specific fees. |
| Non-Refundable Fees | All license fees are non-refundable, with standard fees set at $100 for each license type. |
| Eligibility Criteria | Small Scale Growers may qualify for reduced fees of $40, contingent upon eligibility determined by the Michigan Department of Agriculture. |
| Contact Information | The form includes a contact number (517-241-6666) for inquiries related to the application process. |
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