REGISTRATION OF MEAT AND POULTRY HANDLERS

ABOUT THIS FORM:

Unless you operate under State or Federal Inspection, you are required by law to register with LDAF or USDA if you deal in meat or poultry products in or for commerce.

THIS APPLIES TO: Wholesalers of any carcasses or parts of carcasses of any cattle, sheep, poultry, swine, goats, horses, mules or other equines, whether the product is intended for human consumption or not; Public warehousemen who store carcasses or parts of carcasses of any cattle, sheep, poultry, swine, goats, horses, mules or other equines; Buyers, sellers, and transporters of any dead, dying, disabled or diseased animals or parts of carcasses of such animals (4D Operator); Brokers; Jobbers; Educational programs where carcasses or parts of carcasses are slaughtered, processed, or both; or any combination of the above.

COMPLETE ALL OF THE FOLLOWING SECTIONS AND PROVIDE ADDITIONAL INFORMATION AS REQUESTED.
Check the "original" box to indicate first time registration or check the "update" box for any changes to the original form.*

ORIGINALUPDATE
NAME OF REGISTRANT*

First NameLast Name
MAILING ADDRESS OF REGISTRANT*

Street Address

Street Address Line 2

CityState

Zip Code
PHONE: *
E-MAIL*
example@example.com
FORM OF ORGANIZATION (Check or specify)*

INDIVIDUALLY OWNEDPARTNERSHIPINCORPORATEDCOOPERATIVE ASSOCIATIONLIMITED LIABILITY CORPORATIONOTHER
NATURE OF BUSINESS (Check one)*

MEAT OR MEAT PRODUCTSPOULTRY OR POULTRY PRODUCTSBOTH MEAT AND POULTRY PRODUCTSOTHER
CHECK EACH TYPE OF BUSINESS YOU ARE ENGAGED IN*

BROKERRENDERERWAREHOUSEMANWHOLESALER/JOBBER4D OPERATOROTHER
Input the address(es) of subsidiaries, branches, or divisions of your organization which engage in business of the type identified in "NATURE OF BUSINESS." Include trade or other names if different from your organization's. (If none, state none.) *
PHONE*
E-MAIL*
HOURS OF OPERATION*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
CHANGES: If you make any changes in the names, including trade names, or addresses of the place or places where you do business, report such changes within fifteen (15) days to Louisiana Department of Agriculture and Forestry: Meat and Poultry Inspection Program at 5825 Florida Blvd., Suite 4003, Baton Rouge, LA 70806.

CERTIFICATION BY FIRM OFFICIAL
TYPED NAME OF REGISTERING OFFICIAL*

First NameLast Name
TITLE OF REGISTERING OFFICIAL*
SIGNATURE OF REGISTERING OFFICIAL*

Clear
DATE*

MonthDayYear
Date
Should be Empty: