PSD- 1100 Application for Registration - Packer Buyer

OMB Control No. 0581-0308

United States Department of Agriculture
Agricultural Marketing Service
Fair Trade Practices Program
Packers and Stockyards Division

APPLICATION FOR REGISTRATION
(Under Packers and Stockyards Act, 1921, as Amended and Supplemented)

1.

Name of Applicant to Be Registered (Individual or Firm)

2.

Trade Name/d.b.a. (if applicable)

3a.

Mailing Address

3b. City

3c.

County

4b. City

4c.

County

5.

Telephone

6.

Cell Phone

8.

E-Mail Address

4a.

3d. State

3e.

Zip

4e.

Zip

Operating Address (if different from mailing address)
4d.

9.

State
7.

Fax

Web Site Address

10. Type of Livestock Handled (Check all that Apply)
Cattle

Swine

Sheep and Goats

Horses and Mules

11. Character of Business (Check Applicable Operations)
a.

Market Agency:

Buying on Commission (Order Buyer)

Terminal Stockyard

Clearing Service

Brand Inspection

Selling on Commission - (Select nature of SOC on line 12)

Stockyard Owner

b.

Dealer:

Buying and Selling (if buying on order for others, select "11a. Buying on Commission")

c.

Clearee

Yes

No

d.

Cleared by:

12. Indicate the Nature of your Selling on Commission activities
Posted Stockyard

Commission Firm

Yearly Horse Sale

Date of Sale:

Video

Internet

Tele-Auction

Catalog Sale

Board Sale

Other

13a. Type of Organization (Check One)
Association

L.L.C.

Corporation

L.L.P.

Individual

Partnership

13b. State Formed
14a. Owners, Partners, Members, or Officers
(Name and Title)

Form PSD 1000

Other (Specify)

13c.

Date Formed
14b. %
Ownership

Expires XX/XX/XXXX

14c. Home Mailing Address
(Number, Street, City, State, Zip+4 code)

Page 1 of 6

15. Names and Locations of Posted Stockyards, Auction Markets, Feedlots, and Web Sites Where Applicant Will Operate

16. If Previously Registered, List All Registered Names and Addresses

17. Does Registrant Own or Lease a Scale(s) Used in the Purchase and Sale of Livestock

Yes

No

If yes, List Physical Location of Scale(s), Model, and Serial Number

18. Reporting Year End
Calendar Year Basis

Fiscal Year Basis:

to

19. Auction Market Sale Day(s)
Sun

Mon

Tue

Wed

Thu

Fri

Sat

Market Agency Selling on Commission - Custodial Account Information
20a. Bank
20b. Street

20c.

City

20d.

20f. Telephone

20g. Contact Person

State

20e. Zip+4

CERTIFICATION: I certify my current assets exceed my current liabilities, and, therefore meet the financial requirement of the Packers and Stockyards Act, 1921,
as amended and supplemented; and the application for registration has been prepared by me or under my direction, and that to the best of my knowledge and belief,
this application is true and correct.
21. Signature

21a. Print Name

22. Title

23.

Date

Space Below: TO BE COMPLETED BY PACKERS & STOCKYARDS DIVISION
Registration No.

Date of Acceptance

Type of Registration
NEW
Registered as

AMENDED

REACTIVATED

MARKET AGENCY SELLING ON COMMISSION

DEALER

MARKET AGENCY BUYING ON COMMISSION

BRAND INSPECTION

MARKET AGENCY - CLEARING SERVICES

ALL OTHERS (DESCRIBE)

Registration is required in order to operate as a market agency or dealer subject to the Packers and Stockyards Act, 1921, as amended and supplemented, and 9 CFR
201.10 (a). Information held confidential (9 CFR 201.96)
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 is 0581-0308. The time required to complete this information
collection is estimated to average 1.5 hours 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.
In accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on
the basis of race, color, national origin, sex, age, disability, and reprisal or retaliation for prior civil rights activity. (Not all prohibited bases apply to all programs.)
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.)
should contact the responsible State or local Agency that administers the program or USDA’s TARGET Center at
(202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information is also available in
languages other than English.
To file a complaint alleging discrimination, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office or write a letter addressed to USDA and provided in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (a) mail: U.S. Department of
Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (b) fax: (202) 690-7442; or (c) email:
program.intake@usda.gov.

Form PSD 1000

Expires XX/XX/XXXX

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Instructions to Complete
Application for Registration
Form PSD 1000
Form PSD 1000 is used by applicants to register their operation with the Packers and Stockyards
Division (PSD) as a dealer buying and selling livestock for their own account or for the account
of others, a market agency buying livestock on a commission basis, or a market agency selling
livestock on commission. If any information is missing or incorrect, PSD will return the
application form to the principal for completion or correction.
Operating without proper registration and bond may subject the principal to severe civil penalties
as authorized by law for each violation, and additional penalties for each day the violation
continues (7 U.S.C § 203).
Submit the completed form to the PSD regional office that covers your area. The Areas covered
by each regional office are listed below the regional office's address.
Regional Offices of the Packers and Stockyards Division
Agricultural Marketing Service, Fair Trade Practices Program
Eastern Regional Office
Midwestern Regional Office
Western Regional Office
75 Ted Turner Drive SW, Ste 230 210 Walnut Street, Room 317
3950 Lewiston St., Suite 200
Atlanta, GA 30303-3308
Des Moines, IA 50309-2110
Aurora, CO 80011-1556
Telephone: (404) 562-5840
Telephone: (515) 323-2579
Telephone: (303) 375-4240
FAX: (404) 562-5848
FAX: (515) 323-2590
FAX: (303) 371-4609
E-mail:
E-mail:
E-mail:
PSDAtlantaGA@ams.usda.gov
PSDDesMoinesIA@ams.usda.gov PSDDenverCO@ams.usda.gov
States Covered
States Covered
States Covered
AL, AR, CT, DC, DE, FL, GA,
IA, IL, IN, KY, MB, MI, MN,
AB, AK, AZ, BC, CA, CO, HI,
LA, MA, MD, ME, MS, NC,
MO, ND, NE, OH, ON, SD, WI ID, KS, MT, NM, NV, OK, OR,
NH, NJ, NL, NY, PA, PR, QC,
SK, TX, UT, WA, WY
RI, SC, TN, VA, VT, WV
If you have any questions about the form or completing the form, please contact the PSD
Regional Office that covers your area, as listed above.
Applicants must complete lines 1 through 23, and sign line 21.
If any information for lines 15 and 16 does not fit into the space provided, attach a separate sheet
of paper with the information and include the line number(s) referenced.

Form PSD 1000

Expires XX/XX/XXXX

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Line
No.
1

Subject

Instruction

Name of Applicant to be If you will operate as an individual, enter your first
Registered
name, middle initial and last name. If you will operate as
a partnership, enter each partner’s first name, middle
initial and last name. If you will operate as a corporation,
association, Limited Liability Partnership (L.L.P.), or
Limited Liability Corporation (L.L.C.), enter the name of
the corporation, association, L.L.P., or L.L.C.
2
Trade Name /d.b.a
Enter the trade name/d.b.a under which you, the
applicant, will operate. This is the name the business
will use. If you do not operate with a “Trade Name”,
enter “NA.”
3a
Mailing Address
Enter your mailing address. Enter street, city, county,
through
state, and zip+4. This is the address where all
3e
correspondence, regular and certified from the Packers
and Stockyards Division will be sent.
4a
Operating Address
Enter the operating address and/or physical location.
through
Enter street, city, county, state, and zip+4. This is the
4e
address where you conduct your business services.
5
Telephone, Cell Phone., Enter the telephone number, including area code, where
through Fax, and E-Mail
you may be reached, a cell phone number, a fax number,
8
Address
and, if applicable, the business’ e-mail address.
9
Web Site Address (if
If you operate a web site in conjunction with your
applicable)
livestock operations, enter the complete Web site address
the business operates. For example:
www.WebSiteName.com
10
Type of Livestock
Check the appropriate box(es) to indicate each type of
Handled
livestock the business will be handling.
11a
Character of Business – Check each type of operation that applies to the business.
and
Market Agency/Dealer
If you are completing the application as a stockyard
11b
owner, check the box for Stockyard Owner and add the
name of the stockyard.
11c
Character of Business - If you are named as a Clearee on another registrant’s
Clearee
bonding instrument, check “Yes”. If you provide your
own bonding, check “No” or leave 11c blank.
11d
Character of Business - If you checked “Yes” on 11c, enter the registrant’s name
Cleared by
providing the bond coverage.
12
Nature of Selling on
Check the type(s) of selling on commission activity that
Commission Activities
best describes your business. If operating a yearly horse
sale, include date sale will be conducted. May be month,
or month/day.

Form PSD 1000

Expires XX/XX/XXXX

Page 4 of 6

Line
Subject
No.
13a
Type of Organization
through
13c
14a
through
14c

15

Owners, Members,
Partners, Or Officers,
(Name and Title),
Percent Ownership
Home Address (Street,
City, State, Zip + 4
Code)
Names and location of
posted stockyards,
auction markets,
feedlots, and web sites
where applicant will
operate

16

If Previously
Registered, Registered
Name and Address

17

Does the registrant own
or lease a scale used in
the purchase and sale of
livestock?

18

Reporting Year End

Form PSD 1000

Instruction
Check the appropriate box to indicate the type of
organization as it applies to the business’ operation. If
appropriate, enter the state where the Corporation, LLC,
or LLP was formed on 13b., and the date the
organization was formed on 13c.
For each owner and every partner, enter their name, title,
respective percentage of ownership and home address
(street, city, state, zip+4). Provide this information for
every individual with any ownership interest, in the
applicant’s operation.
IF APPLYING TO OPERATE AS A DEALER OR
MARKET AGENCY, BUYING ON COMMISSION
ORDER BUYER:
Enter the stockyards and markets (including city and
state) where you will conduct business. If you are a
dealer or order buyer, buying in multiple states, insert
“IN COMMERCE” as your answer.
IF APPLYING TO OPERATE AS A MARKET
AGENCY SELLING ON COMMISSION:
Enter the address of the auction market, including city
and state, where you will conduct business.
IF OPERATING AT A WEB SITE:
Enter the web site(s), other than your own, where you
will be purchasing or selling livestock.
If you were previously registered with the Packers and
Stockyards Division, enter ALL name(s) under which
you were previously registered, and the street, city, state,
and zip +4 code of the prior business(es).
Check the appropriate box to indicate if the registrant
owns or leases a scale used in the purchase and sale of
livestock. If yes, enter the location (address, city, state,
and zip +4 code), model, and serial number of each scale,
or attach a copy of the most recent scale test.
Every registrant is required to file an annual report on a
prescribed form. Check the appropriate box to indicate
whether the business is operating/filing on a calendar
year or fiscal year basis, which should be the same as
you file your income taxes. If operating/filing on a fiscal
year basis, enter the beginning and ending dates of the
business’ fiscal year (for example, November 1 to
October 31). If you are filing as a clearee, use the same
filing date as the clearor.

Expires XX/XX/XXXX

Page 5 of 6

Line
No.
19

20a
through
20f

Subject

Instruction

Sale Days-Market
Agency Selling on
Commission

If the applicant intends to operate as an auction market,
check the appropriate box(es) to indicate all days the
market will conduct regular sales. Special sales need not
be included on the application form.
Every market agency selling on commission is required
to establish and maintain a separate bank account
designated “Custodial Account for Shippers’ Proceeds”.

Market Agency Selling
on Commission Custodial Account

For the bank where this account has been established,
enter the name, address, telephone number, and the name
of a contact person.
For more information about the custodial account, please
contact the Packers and Stockyards Division regional
office for your area that is listed on page 1 of this
document.
CERTIFICATION
21
and
21a

Signature (Owner,
Partner, Or
Responsible Officer or
Member), Print Name

22
23

Title
Date

Form PSD 1000

The applicant must sign the application if operating as
an individual.
If the applicant is a partnership, the signature must be
that of a partner.
If the applicant is a corporation, association, L.L.C., or
L.L.P., the signature must be that of an owner, officer, or
member.
Print the name of the person signing the application
Enter the title of the person signing the application.
Enter the date the application is signed by the applicant.

Expires XX/XX/XXXX

Page 6 of 6