Application for Iowa Grain Dealer License

D D

BEFORE THE IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP

APPLICATION FOR IOWA GRAIN DEALER LICENSE

License No. GD-

The undersigned hereby makes application to participate in the Iowa Grain Depositors and Sellers Indemnity Fund in conformity with the

provisions of Iowa Code Chapter 203D and to obtain a Grain Dealer License in conformity with the provisions of Iowa Code Chapter

203 and the Rules of the Department of Agriculture and Land Stewardship, and in support thereof, submits the following information:

Full and correct name of applicant

Corporate Office

Mail Address City State Zip Code

Location of Business

Street Address City County State Zip Code

Mailing Address

Street No. or P.O. Box City State Zip Code

Name of Manager

Business Phone

Fax No.

Applicant is a/an doing business under the name of

(Corporation, Individual, Partnership or Limited Liability Company)

Fiscal Year End of applicant is

INDICATE THE CLASS OF LICENSE WHICH YOU ARE MAKING APPLICATION FOR:

CLASS 1

CLASS 2

Class 1 license is required if the grain dealer will purchase any grain by credit-sale contract, or if the value of grain purchases by the grain

dealer from producers during the grain dealer's fiscal year will exceed $500,000.00.

Class 2 license is required for any grain dealer not holding a class 1 license.

DO YOU WISH TO BE AUTHORIZED FOR CREDIT-SALE CONTRACTS?

YES

Credit-sale contract means a contract for the sale of grain pursuant to which the sale price is to be paid more than thirty (30) days after the

delivery of the grain to the buyer, and includes but is not limited to those contracts commonly referred to as deferred payment, deferred pricing,

price-later, basis, and minimum price contracts.

FEES:

A. In Box A, list the estimated total bushels of grain to be purchased from any source in the next twelve month period:

A) Bushels

B. Multiply the amount in Box A by $0.00014. Enter this amount in Box B.

B)$

C. In box C, enter the greater of the amount in Box B or $50.00. This is your grain indemnity fund participation fee.

C)$

D. For the amount listed in Box A, find the correct license fee in the chart D below:

Chart D PURCHASE AMOUNT LICENSE FEE PURCHASE AMOUNT LICENSE FEE

35,000 bu. or less

$66

1,000,001 to 1,850,000 bu.

$498

35,001 to 250,000 bu.

$116

1,850,001 to 3,200,000 bu.

$706

250,001 to 500,000 bu.

$166

3,200,001 bu. or more

$955

500,001 to 1,000,000 bu.

$291

Divide the fee amount determined in Chart D by 12 and multiply by the number of months from the current

D) $

month to three months past your company's fiscal year end. Enter this in Box D. This is your pro-rated license fee.

E. Enter the total of the amounts in Box C and Box D. This is the total amount due. PAY THIS AMOUNT

E) $

The applicant, if a corporation or a limited liability company, was organized under the laws of the state of

and is

authorized to do business in the State of Iowa , and that the names and addresses of the officers are as follows:

President Address

Secretary Address

Treasurer Address

009-0598 (09/11) (CONTINUED ON REVERSE)

___

}

If applicant is a partnership the partners are as follows:

Name Address

LOCATION OF ALL BRANCH OFFICES TO BE OPERATED UNDER THIS LICENSE :

Applicant will submit such further evidence in support of statements made in the application as required by the Department of Agriculture and

Land Stewardship. As a condition to the granting of this application, applicant agrees to comply with and abide by all the terms of Iowa Code

Chapters 203 and 203D and such rules as are, or may be, prescribed thereunder by the Department of Agriculture and Land Stewardship.

Dated this day of ,

Signature and Title

OATH

State of

ss.

County of

being first duly sworn on oath, depose and say that I am the

Title

of , that I have read the foregoing application, know its purpose,

Business Name

am familiar with the facts therein set forth and the same is true and correct.

Signature

Subscribed and sworn to before me, a Notary Public in and for the State and County above named, this day of

Notary Public

Application must be signed and sworn to by applicant, if an individual; by a member of the partnership, if applicant is a partnership; by a corporate officer

if the applicant is incorporated; or by an authorized manager if the applicant is a limited liability company.

For Office Use Only :

n/w c / r

f /s

csc

whse# fye

Fees:

master gd#

Effective :

Approved by :

009-0598 (09/11)

INSTRUCTIONS FOR PREPARATION OF GRAIN DEALER APPLICATION

1. A Class 1 license is required if the grain dealer is to purchase any grain by credit-sale

contract, or if the value of the grain to be purchased from producers during the dealer's fiscal

year will exceed five hundred thousand dollars ($500,000.00).

An applicant who desires to be authorized to issue credit-sale contracts shall indicate such on the

application form. Be aware that additional requirements are imposed upon dealers who are

authorized to issue credit-sale contracts.

A Class 2 license is required for any grain dealer who expects to purchase 1,000 bushels or more

from producers in any month and who does not hold a class 1 license.

2. FEES: The term of the license runs for one year beginning three (3) calendar months

after the dealer's fiscal year end (this is also the date the dealer's annual financial statement is

due). The license fee will be prorated on a month-to-month basis for new licenses issued for a

period less than a year. A license fee is due based upon the amount of grain purchased. For a

new license, the applicant may pay the lowest fee amount and make adjustments at any time the

dealer exceeds the maximum purchase amount for each fee bracket. Or the applicant may elect

to make an estimate of the amount of purchases to be made and pay the fee for that amount (to

avoid having to make one or more adjustments later).

EXAMPLE:

An applicant with a June 30 fiscal year end applies for a license in August. The applicant

estimates purchases of 550,000 Bushels for their first fiscal year of operations.

The license period for that firm will be October 1 through September 30. The applicant shall

submit the license fee for two months (August and September) along with the application. The

amount due for this applicant is $48.50 ($291.00 divided by 12 multiplied by 2).

Refer to the fee schedule listed on the application form to find the fee due for your firm. Prorate

the fee on a month-to-month basis as shown in this example.

An indemnity fund participation fee is due based upon the amount of grain to be purchased in the

applicant’s first fiscal year. This fee is not prorated. The fee amount is fourteen thousandths of a

cent ($0.00014) per bushel of grain purchased and an adjustment to actual amounts is made at

the end of the applicant’s first complete fiscal year. There is a $50.00 minimum. Call for

assistance on this.

Make your check payable to the Iowa Department of Agriculture & Land Stewardship (made be

abbreviated as IDALS).

3. Corporations, limited liability companies and limited partnerships shall be registered with

the Iowa Secretary of State. Department will verify such registration prior to issuance of license.

Similar verification or documentation may be required of general partnerships.

4. FINANCIAL REQUIREMENTS:

A. The applicant shall file a current financial statement with the application. The

financial statement shall be for the applying entity and not another party such as a parent entity.

See the rule excerpt on the following page regarding applicant financial statements. The

statement shall be prepared in accordance with generally accepted accounting principles and

shall have been reviewed or audited by a Certified Public Account licensed by the state of

Iowa and shall be accompanied by the accountant's unqualified opinion or review report. If you

wish to be authorized to issue credit-sale contracts, be aware that you must either file an audited

financial statement or post a bond or irrevocable letter of credit in the amount of one hundred

thousand dollars ($100,000.00).

B. A Class 1 dealer shall maintain a net worth of $75,000.00.

C. A Class 2 dealer shall maintain a net worth of $37,500.00.

D. All dealers shall maintain a current ratio of 1:1

(current assets shall equal or exceed the current liabilities).

E. Applicant's or dealers who do not meet these minimums may post a bond under

certain situations to cover their deficiency.

F. A dealer's authorization to issue credit-sale contracts may be denied any time

the dealer's current ratio is below 1:1 or any time the dealer's debt to asset ratio

exceeds .75:1 or any time the dealer's net worth does not equal at least fifty cents

($.50) per bushel of grain on credit-sale contract.

Additional requirements apply to the financial statements submitted by sole proprietors.

5. All applications shall be signed by the owner if an individual, a partner if a partnership,

or an officer if a corporate entity. All applications shall be fully completed and notarized.

Applications shall be accompanied by a completed GD-2A (GD-2B for sole proprietors), the

financial statement and the fees.

6. Applications shall be accompanied by a completed Disclosure of Company Ownership,

Control and Management form.

7. File applications with:

Grain Warehouse Bureau

Iowa Department of Agriculture & Land Stewardship

Henry Wallace Building

Des Moines, IA 50319

Phone: 515-281-5987

FAX: 515-281-6800