The Texas Reg 200 form is an official application for obtaining an egg license from the Texas Department of Agriculture. This form serves as a crucial document for businesses involved in the egg industry, ensuring compliance with state regulations. By accurately completing the Reg 200, applicants can facilitate the licensing process and maintain adherence to necessary legal standards.
The Texas Reg 200 form is an essential document for businesses seeking to obtain an egg license from the Texas Department of Agriculture. This form serves multiple purposes, including the application for new businesses and changes in ownership. It requires detailed information about the business type, such as whether it is a corporation, sole proprietorship, or partnership, and mandates the full legal name of the business along with its taxpayer identification numbers. Applicants must also provide contact details for a responsible person, ensuring that the Texas Department of Agriculture can reach them for any license-related matters. Critical sections of the form address facility information, including the physical address where licensed activities will occur, and specify requirements for out-of-state applicants, such as designating a resident agent in Texas. Additionally, the form categorizes businesses based on their operations—dealers, wholesalers, or processors—each with specific fee structures based on estimated weekly volume. Completing the form accurately is crucial, as any misrepresentation can lead to denial or revocation of the license. Timeliness in submitting this application is vital to avoid potential penalties and ensure compliance with state regulations.
P.O. Box 12076 Austin, Texas 78711 (877) 542-2474 (512) 463-7476
Hearing impaired: (800) 735-2988 voice www.agr.state.tx.us
Texas Department of Agriculture
Egg License Application
REG-200
TODD STAPLES, COMMISSIONER
1TYPE OF APPLICATION
SECTION A
SECTION B
New Business
Change of Ownership – previous account number:
2 BUSINESS TYPE
TDA USE ONLY
Corporation
Sole Proprietorship
Client No.
Account No.
Limited Liability Co.
Government
Limited Partnership
Organization
Date (mm/dd/yy)
Initials
General Partnership
3CLIENT INFORMATION
Full legal business name (owner’s name if sole proprietor – no aliases)
D.B.A. (if applicable)
Comptroller Taxpayer ID No.(In-state businesses only) Federal Taxpayer ID No. (Out-of-state businesses only)
SOLE PROPRIETORSHIP ONLY
Social Security No. (SSN - Required)
If you do not have an SSN you must a attach form Affidavit for
-
Occupational License - No Social Security Number (OGC-001)
available at http://www.agr.state.tx.us
Driver License No. ____________________ (if SSN is not available)
TX
State Issued ID No. ____________________ (if DL is not available)
Other
1RESPONSIBLE PERSON INSTRUCTIONS
Please list the full legal name (no aliases or nicknames) of the primary person responsible for the business, as indicated:
For a corporation, limited liability company, or cooperative, the president or CEO,
For a limited or general partnership, the managing partner or general manager,
For a sole proprietorship, the owner,
For any other type of business, the general manager.
2RESPONSIBLE OFFICER, PARTNER, MANAGER, OR OWNER
First Name
M. I.
Last Name
Phone No.
E-mail
(
)
Ext.
This document becomes public record and is subject to disclosure. With few exceptions, you have the right to request and be informed about the information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government Code, Sections 552.021, 552.023, and 559.004.)
Licensing Department
Revised 3/1/12
Administrative Services Division
Occupational
REG-200 Egg License Application
Page 2 of 4
Legal Business Name ______________________________
3 RESPONSIBLE PERSON MAILING ADDRESS
(CONT’D.)B
Address
City
State
Zip
SEC.
Web Address of Business (optional)
1PERSON TO CONTACT FOR LICENSE-RELATED MATTERS
Primary Phone
Secondary Phone (optional)
Fax (optional)
C
SECTION
E-mail Address
***Important Note*** I understand that my email address is required for the Texas Department of Agriculture to keep me
informed of critical information, including licensing and regulatory updates; renewal invoices; and other important
communications. Failure to provide an email address may result in my not receiving time-sensitive information that could
affect my compliance with state regulations, thereby, resulting in monetary penalties.
2MAILING ADDRESS Address
1FACILITY INFORMATION
Facility Name
SECTION D
2PHYSICAL ADDRESS OF LOCATION OF LICENSEE, LICENSED ACTIVITIES OR EQUIPMENT
Address (No P.O. Box)
County
Directions to Physical Location if address above is difficult to find
Page 3 of 4
SECTION E
1OUT-OF-STATE APPLICANTS ONLY
An applicant for an Egg license whose principal place of business is situated outside the State of Texas must appoint and designate a resident citizen of Texas as said applicant’s resident agent within Texas. This information is REQUIRED if the address provided in Section C is out of state.
Who do you wish to designate as resident agent? The Texas Secretary of State Other (list below) Resident Agent Name
Resident Agent Address
Business Phone
SEC. F
SECTION G
1BUSINESS CLASSIFICATION
Dealer-Wholesaler – Complete Section G, #1
Processor – Complete Section G, #2
Broker ($420) – Please skip to Section H
Retailers selling eggs directly to consumers are not required to obtain a license.
1DEALER-WHOLESALER CLASS
Are you a packer?
Yes
No
If yes, please provide USDA Plant No. (if applicable) ________________________
Estimated Average Weekly Volume (check only one)
Class 1
($20)
– 1 case (30 dozen eggs) or more, but less than 10 cases
Class 2
($40)
– 10 cases or more, but less than 50 cases
Class 3
($60)
– 50 cases or more, but less than 100 cases
Class 4
($100) – 100 cases or more, but less than 200 cases
Class 5 ($180)
– 200 cases or more, but less than 500 cases
Class 6 ($270)
– 500 cases or more, but less than 1,000 cases
Class 7
($360) –
1,000 cases or more, but less than 1,500 cases
Class 8
($720) –
1,500 cases or more, but less than 3,000 cases
Class 9
($900) –
3,000 cases or more, but less than 4,500 cases
Class 10 ($1200)
– 4,500 cases or more, but less than 7,000 cases
Class 11 ($1800)
– 7,000 cases or more, but less than 10,000 cases
Class 12 ($2400)
– 10,000 cases or more
2PROCESSOR CLASS
($60) – Less than 250 cases per week
($120)
– 250 cases or more, but less than 600 cases
($210)
– 600 cases or more, but less than 1,500 cases
($420)
– 1,500 cases or more
Page 4 of 4
SECTION H
SECTION I
SECTION J
1PAYMENT
Please see instructions for applicable fees.
REGISTRATION IS NOT VALID UNTIL APPROVED BY TDA.
Method of Payment
(payable to Texas Department of Agriculture)
Check #
Cashier’s Check #
Money Order #
Amount remitted
Mail to: Texas Department of Agriculture
$
P.O. Box 12076, Austin, TX 78711-2076
Receipt No.
Date Receipt Issued
1SIGNATURE
The applicant, by and through their personal or agent's signature below (1) certifies that all information provided in connection with this application at any time is true and correct to the best of the applicant's knowledge; (2) acknowledges that any misrepresentation or false statement made by the applicant, or an authorized agent of the applicant, in connection with this application, whether intentional or not, will constitute grounds for denial, revocation, or non-renewal of any license issued pursuant to this application and/or assessment of monetary administrative penalties; and (3) if applying as an individual, further acknowledges that this application may be denied and that any license issued pursuant to this application may be suspended, revoked, or denied renewal due to delinquency in payment of a guaranteed student loan and that any license issued pursuant to this application may be suspended or denied renewal for failure to pay child support. If signed by an agent (including employee) of the applicant, the person signing certifies that he or she is authorized to make the preceding certifications on behalf of the applicant.
Applicant Name
Title
Applicant Signature
Date
/
month
day
year
1CHECKLIST
Please use this checklist to ensure you are sending all of the necessary information and documents.
Fee (see instructions for assistance with calculating the correct fee.)
Please note that an incomplete application may result in processing delays.
Transfer License - Helps in quick resolution of disputes by laying down the specific terms of coverage.
Child Support Forgiveness Form - Failure to update required information may lead to legal consequences, including potential fines and jail time.