Qualified Produce Safety Rule Exemption Renewal

Mississippi Department of Agriculture & Commerce · Produce Safety Division
#if("#text(#field(17528))" == "Yes")#endif
Applicant & Farm Information
Applicant Name#text(#field(17508)) #text(#field(17509))
Name of Farm#text(#field(17510))
Email#text(#field(17511))
Addresses
Farm (Physical) Address
#text(#field(17513))
#if(#field(17514))
#text(#field(17514))
#endif
#text(#field(17515)), #text(#field(17516)) #text(#field(17517))
Mailing Address
#if("#text(#field(17520))" == "Mailing address is the same as the farm (physical) address")Same as farm (physical) address#endif#if("#text(#field(17520))" != "Mailing address is the same as the farm (physical) address")
#text(#field(17521))
#if(#field(17522))
#text(#field(17522))
#endif
#text(#field(17523)), #text(#field(17524)) #text(#field(17525))
#endif
Farm Status
Farm still in business?#text(#field(17528))
Sales to Qualified End Users (QEU's)
#text(#field(17533))$#text(#field(17534))
#text(#field(17535))$#text(#field(17536))
#text(#field(17537))$#text(#field(17538))
Average Food Sales to QEU's$#text(#field(17539))
Sales to Non-QEU's
#text(#field(17541))$#text(#field(17542))
#text(#field(17543))$#text(#field(17544))
#text(#field(17545))$#text(#field(17546))
Average Food Sales to Non-QEU's$#text(#field(17547))
Submission
Submission ID#submit_id