Form CN-246 Application for License to Sample Cotton under the Unite

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REPRODUCE LOCALLY. Include form number and edition date on all reproductions.
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
COTTON PROGRAMS

APPLICATION FOR LICENSE
TO SAMPLE COTTON
UNDER THE
UNITED STATES
COTTON STANDARDS ACT

OMB APPROVED - NO. 0581-0008

This application is authorized by law, 7 U.S.C. 51 et. seq. (U.S. Cotton Standards Act) and U.S.C. 473 c et. seq. (Smith-Doxey Act) and the regulations
issued thereunder (7 CFR Part 28). Furnishing the information is voluntary and no penalty will be imposed for failure to respond; however, this
information is necessary if we are to issue the license.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0008. The time
required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin,
gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.)
Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.)
should contact USDA's TARGET Center at 202-720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW,
Washington, DC 20250-9410 or call 202-720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.

INSTRUCTIONS: Answer all questions and send one completed application to the address shown at the bottom of the page. A company operating more than
one warehouse or gin may submit one application for all warehouses or gins. However, the name, location, and mailing address of each warehouse or gin to be
licensed should be listed on Page 2. A separate license will be issued for each warehouse or gin.
1. NAME IN WHICH BUSINESS IS CONDUCTED (Print or type):

2. TYPE OF BUSINESS FOR WHICH
APPLICATION IS BEING MADE
(Mark an "X" in appropriate block):
COTTON GIN
COTTON WAREHOUSE

3. LOCATION OF BUSINESS (Street and number, City State, and Zip Code):

4. MAILING ADDRESS (Street or P.O. Box Number, City, State, and ZIP Code):

5. NUMBER OF WAREHOUSES OR GINS
OPERATED:

Enter your E-Mail address here:
6. BUSINESS IS (Mark an "X" in appropriate block):
OWNED BY ONE PERSON

A PARTNERSHIP

A CORPORATION

AN ASSOCIATION

7. IF THIS APPLICATION IS FOR A
WAREHOUSE, IS COTTON STORED
FOR THE PUBLIC (Mark an "X" in
appropriate block):
NO

YES

CERTIFICATION STATEMENT: The undersigned, as a condition to the granting of the license, agrees to comply with
and abide by the terms of the United States Cotton Standards Act and Regulations. The statements made in the
foregoing application are hereby certified to be true to the best of the knowledge and belief of the undersigned.
NOTE: Application must be signed by the owner or a responsible official of the warehouse or gin.
If submitted electronically, type your name in the signature block.
SIGNATURE

TITLE

SUBMIT ELECTRONICALLY OR MAIL TO:

Abilene Classing Office, 24 Windmill Circle, Abilene, TX 79606

DATE

FOR USE BY COTTON PROGRAMS ONLY
DATE LICENSE ISSUED

LICENSE NUMBER

CN-246 (09-03)

(Previous editions are to be destroyed)

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.

OMB APPROVED – No. 0581-0008

APPLICATION FOR LICENSE TO SAMPLE COTTON
UNDER THE UNITED STATES COTTON STANDARDS ACT
INSTRUCTIONS: This page should be used to provide additional names, locations and
mailing addresses of warehouses or gins to be licensed.
NAME IN WHICH BUSINESS IS CONDUCTED

NAME OF OWNER OR RESPONSIBLE OFFICIAL

NAME, LOCATION, AND MAILING ADDRESS (If Different) OF ADDITIONAL WAREHOUSES OR GINS (Street or P.O.
Box Number, City, State, and Zip Code)

NAME IN WHICH BUSINESS IS CONDUCTED

NAME OF OWNER OR RESPONSIBLE OFFICIAL

NAME, LOCATION, AND MAILING ADDRESS (If Different) OF ADDITIONAL WAREHOUSES OR GINS (Street or P.O.
Box Number, City, State, and Zip Code)

NAME IN WHICH BUSINESS IS CONDUCTED

NAME OF OWNER OR RESPONSIBLE OFFICIAL

NAME, LOCATION, AND MAILING ADDRESS (If Different) OF ADDITIONAL WAREHOUSES OR GINS (Street or P.O.
Box Number, City, State, and Zip Code)

Page 2

CN-246 (09-03) (Previous editions are to be destroyed)

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