The information on this form will be submitted to the Montgomery County Department of Permitting Services in order for the applicant to be approved as a Certified Agricultural Producer to sell the following items in the PUBLIC RIGHT OF WAY: regionally grown fresh fruits, vegetables, herbs, cut flowers, small trees, and plants, as well as any non-potentially hazardous prepackaged goods and eggs with approval from the Montgomery County Department of Health and Human Services (for more information or to receive a Health Department application please call 240-777-3986).
Date:
Full Name:
Mailing Address:
Do you intend to sell agricultural products that you produce?
Farm Address
Do you have a second farm location?
Second Farm Address:
Do you have a third farm location?
Third Farm Address:
Do you intend to sell agricultural products from a farm you do not operate or own?
Upload a letter from each farm you will be purchasing from certifying that you will be sourcing from them and listing the specific products.
Upload first letter
Upload second letter
Upload third letter
Upload fourth letter
Upload fifth letter
Do you intend to sell any products that require approval from the Dept. of Health and Human Services (DHHS)?
Agricultural producer's signature: