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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 3d. State 3e. Zip 

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

4b. City 4c. County 4d. State 4e. Zip 

5. Telephone 6. Cell Phone 7. Fax

8. E-Mail Address 9. 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 

Board Sale

d. Cleared by:

12. Indicate the Nature of your Selling on Commission activities

Posted Stockyard Commission Firm Video Internet Tele-Auction Catalog Sale Other 

Yearly Horse Sale Date of Sale:

13a. Type of Organization (Check One) 

Association L.L.C.

Corporation L.L.P.

Individual Partnership

Other (Specify) 

13b. State Formed 13c. Date Formed 

14a. Owners, Partners, Members, or Officers 

(Name and Title) 

14b. % 

Ownership 

14c. Home Mailing Address 

(Number, Street, City, State, Zip+4 code) 

Form PSD 1000 Expires 01/31/2025 Page 1 of 2 
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: 

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to 

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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. State 20e. Zip+4

20f. Telephone 20g. Contact Person 

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 AMENDED REACTIVATED 

Registered as MARKET AGENCY SELLING ON COMMISSION DEALER 

MARKET AGENCY BUYING ON COMMISSION 

MARKET AGENCY - CLEARING SERVICES 

BRAND INSPECTION 

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 01/31/2025 Page 2 of 2