PMMB-77
Rev. 04/16
Commonwealth of Pennsylvania
MILK MARKETING BOARD
2301 North Cameron Street
Harrisburg PA 17110-9408
Phone: 717-787-4194 Website: www.mmb.pa.gov
Fax: 717-705-2712
MILK HAULER’S LICENSE RENEWAL APPLICATION
Licensing year July 1, 2016 through June 30, 2017
Application is due on or before June 15, 2016
(Please Do Not Provide Any Social Security Numbers)
Fixed Fee -- $30.00
Haulers of milk in cans are EXEMPT from this fee. However, this application must be completed.
______
PLEASE PRINT OR TYPE:
License Number ______
Business or Trade Name______
Contact Person ______
Phone #______Fax # ______
Mailing Address______
(Street) (County)
______
(City) (State) (Zip Code)
Email Address (if applicable)______
Web Address (if applicable)______
If a Corporation, state in which incorporated ______Date Incorporated ______
Were you ever licensed by the PA Milk Marketing Board as a Milk Hauler? Yes______No ______
Do you haul milk in cans? Yes______No______
List the name and license number of each Pennsylvania weigher/sampler employed or otherwise utilized by applicant.
(Use additional paper, if necessary.) THIS APPLICATION WILL BE RETURNED IF THIS SECTION IS NOT COMPLETED.
Name License # Name License #
______
______
______
List the names of all Dealers for whom applicant is hauling milk or cream.
(Use additional paper, if necessary.)
______
______
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PLEASE SIGN APPLICATION ON REVERSE SIDE.
A hauler’s license fee of thirty dollars ($30.00), which can be paid by check or money order, payable to the “Commonwealth of Pennsylvania”, must accompany this application.
If at any time during the licensing period there is a change to any information contained in this application, please notify the Milk Marketing Board. If you should discontinue operating as a hauler, please notify the Milk Marketing Board in writing, and return your hauler’s license.
“Application is hereby made for a Milk Hauler’s License under the provisions of the Milk Marketing Law approved April 28, 1937 P.L. 317, as amended. The undersigned hereby affirms that the foregoing information is true and correct to the best of said person’s knowledge, information and belief, said affirmation being made subject to the penalties prescribed by 18 Pa.C.S. Section 4904 (relating to unsworn falsification to authorities).”
Signature______Date______
Type or Print Name as signed above______
Reminder:Once becoming licensed as a hauler:
Ø The PMMB-79 Milk Hauler’s Report must be completed and filed by all Milk Haulers on a monthly basis. This report identifies the prior month’s hauling activity and must be filed on or before the 30th of each month. A report is required even if there was no activity to report. Failure to comply with this filing requirement may be subject to possible legal referrals.
Ø In addition to the annual fixed fee of $30.00, all licensed Milk Haulers shall pay the sum of $.005 per hundred weight on all milk hauled, computed as follows:
A. All milk picked up at a producer’s farm located outside of PA and delivered to a
dealer or handler located within PA.
B. All milk picked up at a producer’s farm located within PA and delivered to a dealer
or hauler located within or outside PA.
C. The payment due must accompany the milk hauler’s monthly report.
There is a $20.00 service charge for any returned checks.