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Get NY FSI-898c 2017

I understand that my product labels must comply with the listed requirements. initial I have read FSI-898d Home Processing fact sheet and agree to comply with the listed provisions. FSI-898c Rev* 01/17 NYS Department of Agriculture and Markets Division of Food Safety and Inspection HOME PROCESSOR REGISTRATION REQUEST Date Owner Name County Trade Name Street Address City Phone Number Zip Code E-mail/Website Address LIST COMMON OR USUAL NAME OF THE NON POTENTIALLY HAZARDOUS PRODUCTS THAT YOU PROPOSE TO MANUFACTURE AS A 20C EXEMPT HOME PROCESSOR* IF NECESSARY INCLUDE A BRIEF DESCRIPTION OF THE PRODUCT. 1. 2. Products are subject to approval and approval must be obtained for any added products after initial registration --------------------------------------------------------------------------------------------------------------------------------MUST CHECK ONE Water supply is a private well public/municipal supply predominance by weight net quantity of contents and processor name and full address. initial By signing this form I acknowledge that I have read and understand the provisions of the 20C Exempt Home Processing registration* I agree to these provisions and limitations of the exemption particularly as it concerns products that may be produced and permitted sales venues. I further understand that violations of this agreement will result in revocation of my home processing registration and I may be subject to civil penalties. Signature of Home Processor For office use only Reviewers Date Reviewed Approved Yes No Reason not approved. FSI-898c Rev* 01/17 NYS Department of Agriculture and Markets Division of Food Safety and Inspection HOME PROCESSOR REGISTRATION REQUEST Date Owner Name County Trade Name Street Address City Phone Number Zip Code E-mail/Website Address LIST COMMON OR USUAL NAME OF THE NON POTENTIALLY HAZARDOUS PRODUCTS THAT YOU PROPOSE TO MANUFACTURE AS A 20C EXEMPT HOME PROCESSOR* IF NECESSARY INCLUDE A BRIEF DESCRIPTION OF THE PRODUCT. 1. 2. Products are subject to approval and approval must be obtained for any added products after initial registration --------------------------------------------------------------------------------------------------------------------------------MUST CHECK ONE Water supply is a private well public/municipal supply predominance by weight net quantity of contents and processor name and full address. initial By signing this form I acknowledge that I have read and understand the provisions of the 20C Exempt Home Processing registration* I agree to these provisions and limitations of the exemption particularly as it concerns products that may be produced and permitted sales venues. I further understand that violations of this agreement will result in revocation of my home processing registration and I may be subject to civil penalties. I further understand that violations of this agreement will result in revocation of my home processing registration and I may be subject to civil penalties. Signature of Home Processor For office use only Reviewers Date Reviewed Approved Yes No Reason not approved. .

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