UNIVERSITY OF KENTUCKY
FOR SPECIALTY FERTILIZERS IN PACKAGES OF 10 POUNDS OR LESS
APPLICATION FOR REGISTRATION OF SPECIALTY FERTILIZERS IN KENTUCKY UNIVERSITY OF KENTUCKY
College of Agriculture Mail Completed Application to: College of Agriculture
Division of Regulatory Services Coordinator, Fertilizer Regulatory Program Division of Regulatory Services
An Equal Opportunity University 103 Regulatory Services Building - Lexington, KY 40546-0275 An Equal Opportunity University
Application is hereby made for the registration of the brands and grades of specialty fertilizers listed below for the period ending December 31, 20____.
We agree that the company name and address appearing after “REGISTERED FOR” will be printed on each container associated with the fertilizer and upon approval of this application
said company assumes full responsibility for compliance with all requirements of the Kentucky Fertilizer Law and Regulations.
Labels MUST be attached for each new brand and grade for which registration is requested
Check one or more: __New __Renewal with no changes __Renewal with corrections __Renewal with deletions
___Registered FOR_________________________________ Address__________________________ City_______________________ State________ Zip____
___Registered BY_________________________________ Address__________________________ City_______________________ State________ Zip____
(If different from above)
___Annual Insp. Fees___ ___________________________ Address__________________________ City_______________________ State________ Zip____
(If different from above)
Check one or more: ___Mixed Blend ___Mixed Amm-Gran ___Mixed Liquid(clear) ___Mixed Liquid(susp) ___Material
Date ____________ Signature ______________________________ _____________________________ Phone ( ) ____________ Fax ( ) ____________
(printed name and title)
BRAND NAME AND GRADE NET WEIGHT OF GUARANTEED ANALYSIS* S/M* ID/LABEL#** REGR. AN. TOTAL
OF FERTILIZER OR PKGS. FEES INSP.
N P2O5 K2O
FERTILIZER MATERIAL FEES
*Guarantees other than NPK must be on label and the S/M column checked (√).
**Place the ID number or your product number from each attached label in this column.
DO NOT SEND MONEY WITH APPLICATION. You will be billed when labels and application are approved.
DO NOT WRITE IN THIS SPACE -- FOR USE OF DIVISION OF REGULATORY SERVICES ONLY APPLICANT -- Return all copies
Check Amount _________________ Check Number ____________________ Date of Check ____________________ Date Received ________________________
Total Fees Due (This Report) $_________________