<p> GEORGIA DEPARTMENT OF AGRICULTURE 19 Martin Luther King Jr. Dr. SW, Atlanta, Georgia 30334-4201 Annual Application For Lime License / Renewal Application is hereby made to obtain / renew a Lime License in the State of Georgia for the Fiscal year ending June 30, ______.</p><p>APPLICANT NAME DATE □ Individual □ Partnership □ Corporation BUSINESS NAME TYPE OF (if different) BUSINESS □ Legal Trust □ ______</p><p>ADDRESS CITY STATE ZIP</p><p>TELEPHONE NO. FAX NO. FEIN or SSN# □ Owner □ Partner AUTHORIZED SIGNATURE □ Corporate Officer ______Title</p><p>CONTACT PERSON (print) EMAIL </p><p>The License Fee is determined by the amount of Lime Tonnage sold during the previous fiscal year, and for renewals, the date the fee is received. FEE MUST BE SUBMITTED WITH APPLICATION. CHECK ONE BOX BELOW. A copy of this form will be returned for your records.</p><p>NEW LICENSE $70 □</p><p>RENEWALS: Last Years Tonnage Date Fee Received . By July 1 July 2-July 31 August 1-August 31 Sept. & later Less Than 10,000 $ 70 □ $ 105 □ $ 140 □ $ 175 □ 10,000 or more $100 □ $ 210 □ $ 280 □ $ 350 □</p><p>Are you a Lime Manufacturer? YES □ NO □</p><p>Are materials obtained by mining? YES □ NO □ Are materials obtained as By-Product? YES □ NO □</p><p>Describe Process:______</p><p>This License expires on “June 30”, but, for so long as appropriate fees thereon are paid, and an Annual Application for Lime License / Renewal is completed and received by the Commissioner, may be deemed to be renewed from fiscal year to fiscal year unless surrendered, abandoned, revoked or canceled.</p><p>MAIL TO: Georgia Department of Agriculture, Seed, Fertilizer & Feed Section, 19 MLK Jr. Dr., SW, Atlanta, Georgia 30334-4201 FOR DEPARTMENTAL USE ONLY FOR DEPARTMENTAL USE ONLY FOR DEPARTMENTAL USE ONLY </p><p>Date: ______</p><p>Check #:______</p><p>Check $: ______</p><p>Company ID #:______BY______PROGRAM DIRECTOR SFF-LIME LICENSE</p>