Farm Registration Form 2015

Farm Registration & Farm Organizations Funding Act
Farm Registration Form 2015
Office Use Only
Date
Farm Registration No.
Farm Business Name:
Farm Location Civic Address and Community:
Farm Operator or Corporate /Partnership Contact Person:
Name:
Civic Address & Postal Code:
Telephone: Fax:
E-mail:
Farm Legal Status:
Individual Ownership Partnership Corporation
Name(s) of Farm Partners
(only applicable if the farm business is a partnership):
General Farm Organization I wish to support (check one box only):
PEI Federation of
Agriculture
Gross Income Registration Fee HST Total Fee
0 to $ 99,999 ….……. $150.00 + $21.00
HST
= $171.00
$100,000 to $250,000.. $250.00 + $35.00
HST
= $285.00
Greater than $250,000.. $375.00 +$52.50
HST
= $427.50
National Farmers Union
Gross Income Registration Fee
0 to $ 99,999 ….………..…. $150.00
$100,000 to $250,000……... $250.00
Greater than $250,000……... $375.00
Payment Information
Check the appropriate Organization box above. Depending on your
annual gross income from farming for the immediate preceding
taxation year, check the appropriate Fee box.
Submit completed form and cheque to address to the right
before April 1, 2015:
Registration Fee Enclosed $ ____________
Check this box only if you DO NOT CONSENT to
the sharing your contact information with your supported
farm organization.
(Consent is required in accordance with
the Freedom of Information and Protection of Privacy Act.)
Refunds - If you wish a refund, you must contact the farm organization in writing by June 1, 2015.
Consents
Personal information on this form is collected under Section 6 of the Farm Registration and Farm Organizations
Funding Act as it relates directly to and is necessary for the registration of farms. The Department of Agriculture and
Forestry may use the information to determine eligibility for its programming.
Signature and Declaration
I hereby declare that the information I have provided is, to the best of my knowledge, accurate and complete.
__________________________________________ ______________________________
Signature Date
Make cheque payable to:
“Registrar of Farms”
Mail to
Registrar of Farms
c/o Carolyn Wood
PO Box 2000
Charlottetown PE
C1A 7N8
Or deliver to
Registrar of Farms
5
th
Floor Jones Building
11 Kent Street
Charlottetown, PE
368-4145 or 1-866-734
-3276
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Farm Registration Form 2015 PDF

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