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VIRGINIA DEPARTMENT
OF AGRICULTURE AND
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ABOUT VDACS
ANIMALS
CONSERVATION & ENVIRONMENTAL
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FOOD, FOOD SAFETY & CONSUMER PROTECTION
INSPECTION & GRADING SERVICES
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PESTICIDES
PLANT, PEST, FEED, FERTILIZER & SEED
SERVICES/FORMS
SERVICES/FORMS
Animal Health
Animal Custody Record
Animal Custody Record Online Reporting System—User Login
Animal Custody Record Online Reporting System—Public Report Search
Animal Care Complaint Form
Animal Health Laboratory Fee Schedule
Animal Health Laboratory Submission Form
Agricultural Animal Seizure Report
Application for Livestock Dealer Registration
Application for Poultry Dealer Registration
Dangerous Dog Registration Form
Dangerous Dog Renewal Form
Dangerous Dog Secondary Owner Information Form
Virginia Dangerous Dog Registry
Equine Event Report
Equine Event Denied Entry Report
Poultry Service Request Form & Fees
Charitable Gaming
Bingo Managers & Callers
Online Bingo Manager & Bingo Caller Registration System
Bingo Manager Certificate of Registration Application – Form 402 (pdf)
Bingo Manager Certificate of Registration Application – Form 402 (xls)
Bingo Caller Certificate of Registration Application – Form 401 (pdf)
Bingo Caller Certificate of Registration Application – Form 401 (xls)
Bingo Manager Training Material
Bingo Caller Training Material
List of Registered Bingo Caller
List of Registered Bingo Manager
Organization Licensing
Tips for using the interactive Excel Bingo/Raffle Applications
Bingo/Raffle/Texas Hold’em Poker Tournament Application - New Applicant (pdf)
Bingo/Raffle/Texas Hold’em Poker Tournament Application - Renewal Applicant (pdf)
Permit Amendment (pdf)
Gaming Personnel Information Update (pdf)
Report of Game Termination, Revised (pdf)
Landlord & Texas Hold’em Poker Tournament Operator Registering
Landlord Registration Application (pdf)
Operator Registration Application (pdf)
Supplier Licensing
Charitable Gaming Supplier Permit Application – Form 301 (Revised 02/26/18)
Certification of Non-Permit Holder – Form 303 (Revised 07/15/21)
Certification of Non-Charitable Gaming/Gambling – Form 304 (Revised 07/30/13)
Annual Supplier Sales and Transactions Report - Form 302 (Revised 08/01/13) (pdf)
Annual Supplier Sales and Transactions Report - Form 302 (Revised 08/01/13) (xls)
Instructions (Revised 07/30/13)
Supplier Transaction Reporting Format
Manufacturer of Electronic Pull-Tab System Licensing
11 VAC 15-40, Charitable Gaming Regulations.
Currently Registered Manufacturers of Electronic Pull-Tab System
Manufacturer of Electronic Pull-Tab System Permit Application – Form 305 (Revised 10/12)
Manufacturer of Electronic Pull-Tab System Permit Application – Personal Information Form – Form 305-A (Revised 10/12)
Manufacturer of Electronic Pull-Tab System Permit Renewal Application – Form 306 (Revised 10/13)
Manufacturer of Electronic Pull-Tab System Permit Renewal Application – Personal Information Form – Form 306-A (Revised 10/13)
Game Management Forms and Complaints
Form 103 - Bingo Session Reconciliation Summary (Revised 10/24/2022) - Required (pdf)
Form 103 - Bingo Session Reconciliation Summary (Revised 10/24/2022) - Required (xls)
Form 103 - Instructions (Revised 10/24/2022)
Form 104-A - Admission Sales Reconciliation - Paper (Revised 03/23/23) -
Required
(pdf)
Form 104-A - Admission Sales Reconciliation - Paper (Revised 03/23/23) -
Required
(xls)
Form 104-A - Instructions (Revised 03/23/23)
Form 104-B - Floor Sales Reconciliation - Paper (Revised 12/19/14) (pdf)
Form 104-B - Floor Sales Reconciliation - Paper (Revised 12/19/14) (xls)
Form 104-B - Instructions (Revised 12/19/14)
Form 104-C - Decision Bingo Reconciliation (Revised 08/14/13) -
Required
(pdf)
Form 104-C - Decision Bingo Reconciliation (Revised 08/14/13) -
Required
(xls)
Form 104-C - Instructions (Revised 07/30/13)
Form 104-D - Raffle/Treasure Chest Sales Reconciliation - Bingo Session (Revised 03/23/23) -
Required
(pdf)
Raffle/Treasure Chest Sales Reconciliation - Bingo Session (Revised 03/23/23) -
Required
(xls)
Form 105 - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation (10/24/2022) -
Required
(pdf)
Form 105 - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation (10/24/2022) -
Required
(xls)
Form 105 - Instructions (Revised 10/24/2022)
Form 105-A - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Continuation (Revised 08/05/13) -
Required
(pdf)
Form 105-A - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Continuation (Revised 08/05/13) -
Required
(xls)
Form 105-A - Instructions (Revised 08/02/13)
Form 106-A - Storeroom Inventory Issue - Paper (Revised 08/01/13) - Optional (pdf)
Form 106-A - Storeroom Inventory Issue - Paper (Revised 08/01/13) - Optional (xls)
Form 106-A - Instructions (Revised 08/01/13)
Form 106-B - Storeroom Inventory Issue - Instant Bingo/Seal Cards/Pull-Tabs (Revised 08/01/13) - Optional (pdf)
Form 106-B - Storeroom Inventory Issue - Instant Bingo/Seal Cards/Pull-Tabs (Revised 08/01/13) - Optional (pdf)
Form 106-B - Instructions (Revised 08/01/13)
Form 107 - List of Bingo Workers Form (Revised 08/01/13) (pdf)
Form 107 - List of Bingo Workers Form (Revised 08/01/13) (xls)
Form 107 - Instructions (Revised 08/01/13)
Form 108 - Prize Receipt Form (Revised 08/01/13) (pdf and xls)
Form 108 - Prize Receipt Form (Revised 08/01/13) (pdf and xls)
Form 108 - Instructions (Revised 08/01/13)
Form 109-A - Storeroom Inventory - Paper (Revised 08/01/13) -
Required
(pdf)
Form 109-A - Storeroom Inventory - Paper (Revised 08/01/13) -
Required
(xls)
Form 109-A - Instructions (Revised 07/30/13)
Form 109-B - Storeroom Inventory Form - Instant Bingo/Seal Cards/Pull-Tabs (Revised 08/01/13) -
Required
(pdf)
Form 109-B - Storeroom Inventory Form - Instant Bingo/Seal Cards/Pull-Tabs (Revised 08/01/13) -
Required
(xls)
Form 109-B - Instructions (Revised 08/01/13)
Form 110 – Raffle Sales Reconciliation Form – Stand Alone Raffle (Revised 08/01/13) (pdf)
Form 110 – Raffle Sales Reconciliation Form – Stand Alone Raffle (Revised 02/26/18) (xls)
Form 110 – Instructions (08/01/13)
Form 111 - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Form (Non-Bingo) (Revised 5/24) (pdf)
Form 111 - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Form (Non-Bingo) (Revised 5/24) (xls)
Form 111 - Instructions (Revised 08/05/24)
Form 111-A - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Continuation Form (Non-Bingo) (Revised 5/24) (pdf)
Form 111-A - Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Continuation Form (Non-Bingo) (Revised 5/24) (xls)
Form 111-A - Instructions (Revised 08/05/24)
Form 111-B – Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Continuation Form (Non-Bingo) (Revised 5/24) (pdf)
Form 111-B – Instant Bingo/Seal Cards/Pull-Tabs Reconciliation Continuation Form (Non-Bingo) (Revised 5/24) (xlsx)
Form 111-B - Instructions (Revised 08/05/24)
Form 112 - Destruction of Unused Charitable Gaming Supplies (Revised 03/06/14) (pdf)
Complaint Poster (Revised 11/21/17) (pdf)
Form 114 - King of Clubs/Queen of Hearts/Raffle Sales Reconciliation – Social Quarters (Revised 5/18/23) - Required (xlsx)
Form 114 – King of Clubs/Queen of Hearts/Raffle Sales Reconciliation – Social Quarters (Revised 5/18/23) - Required (pdf)
Form 117 – Texas Hold’em Poker Tournament Reconciliation Summary (Revised 5/24) – Required (pdf)
Form 117 – Texas Hold’em Poker Tournament Reconciliation Summary (Revised 5/24) – Required (xlsx)
Form 117 - Instructions (Revised 08/05/24)
Charitable Solicitation
Virginia Exemption Application for Charitable or Civic Organization: (Form 100)
Registration Statement for a Charitable Organization: (Form 102)
Professional Fundraising Registration: (Form 103)
Professional Solicitor Registration: (Form 104)
Professional Solicitor Bond Template: (Form 105)
Solicitation Notice: (Form 120)
Consent to Solicit: (Form 121
Professional Solicitor’s Final Accounting Report Late Fees: (Form 130)
Schedule A – Accounting For All Ticket Sales, Including Solicitation for Donated Tickets: (Form 131)
Commitment for Receipt of Donated Tickets: (Form 132)
Virginia Solicitation of Contributions Law
Rules Governing the Solicitation of Contributions
Unified Registration Statement: This form may be utilized by charitable organizations soliciting in multiple states.
Charitable Solicitation Complaint Form
Credit Services Business
Credit Services Business Registration Form (OCRP-71
Credit Services Business Bond: Template (OCRP-74)
Credit Services Business Irrevocable Letter of Credit:
Template
(OCRP-73
Virginia Credit Services Businesses Act
OCRP Regulatory Programs Complaint Form
Extended Service Contract
Extended Service Contract Provider/Obligor Application for Registration
(OCRP-61)
Virginia Extended Services Contract Providers Act
OCRP Regulatory Programs Complaint Form
Fantasy Contests
Complaint Form
Form 501 - Fantasy Contest Operator Registration Application
Form 501-A – Personal Information Form
Feed, Fertilizer & Seed
CFA Certification Online Application
Commercial Animal Feed Purchasing Report
Commercial Animal Feed Statement of Agreement
Commercial Animal Feed Tonnage Reporting and Payment Agreements Instructions
Fertilizer Tonnage Reporting System
Fertilizer, Soil Amendment, Horticultual Growing Medium Purchasing Report
Fertilizer, Soil Amendment, Horticultural Growing Medium Statement Of Agreement
Fertilizer, Soil Amendment, Horticultural Growing Medium Tonnage Reporting and Payment Agreements Instructions
Industrial Co-Products Guidance
License Packet for Agricultural Products Dealer
License and Product Registration Packet for Commercial Feed
License and Product Registration Packet for Fertilizer
License and Product Registration Packet for Lime
License and Product Registration Packet for Seed
Turf Fertilizer Reporting Tool
Virginia Fertilizer/Lime Contractor — Applicator Permit
Food
Commercial Kitchen Food Processing Application
Home Food Processing Application
Wild Mushroom Harvester Application
Wild Mushroom Retail Sales Application
Fruit, Vegetable & Peanut Marketing Services
Fruit and Vegetable Programs Request for Inspection, Reinspection or Appeal Inspection
Health Clubs
Health Club Registration Form
(OCA-31)
Health Club Bond
Template
(OCA-34)
Health Club Letter of Credit
Template
(OCA-33)
Health Club Act
OCRP Regulatory Programs Complaint Form
Home Operations
Home Food Processing Application
Home Service Contracts
Home Service Contract Provider Registration Application (Form 801)
Home Service Contract Provider Bond Form (Form 802)
Home Service Contract Provider Line of Credit Form (Form 803)
OCRP Regulatory Programs Complaint Form
Market News Service
Hay Clearing House Request Form
Market News Publications Request Form
Meat & Poultry Services
Application for Permit of Exemption
Application for Permit of Poultry Exemption
Application/Approval for Voluntary Reimbursable Inspection Service
Membership Campgrounds
Application for the Registration of Membership Camping Operator
(OCRP-51)
Membership Campground Letter of Credit
Template
(OCRP-53)
Membership Camping Operator's Bond
Template
(OCRP-54)
Virginia Membership Campground Act
OCRP Regulatory Programs Complaint Form
Payment Portal
Payment Portal
Pesticide Services
Application for New Pesticide Product Registration
Application for Reciprocal Pesticide Applicator Certificate
Application for Virginia Pesticide Business License
Applicator Change of Information
Business Change of Information
Business License Application Instructions
Certificate of Insurance
Complete Business License Packet
Complete Commercial Pesticide Applicator Packet
Complete Registered Technician Packet
Commercial A Pesticide Applicator Certification Application
Commercial Application Instructions
Commercial B Pesticide Applicator Request for Authorization to Take Pesticide Applicator Examination
Pesticide Registered Technician A Application
Pesticide Registered Technician B Application
Pesticide Disposal Registration Form
Power of Attorney
Private Pesticide Applicator Application and Request for Authorization to Take the Pesticide Applicator Examination
Proof of Additional Category Specific Training for Registered Technicians
Registered Technician Instructions
Request to take the Virginia Pesticide Business License Examination
Responsibilities of Commercial Pesticide Applicators and Registered Technicians in Virginia
Training Manual Order Form
Virginia Pesticide Discontinuance Policy
Plant Industry Services
Permit Application
Virginia Pollinator Beekeeper Form
Virginia Ginseng Management Program
Virginia Plants and Plant Product Inspection Law and Quarantine Requirements
Prepaid Legal Service Plan Sellers
Online Registration Application
Virginia Prepaid Legal Services Plan Act
OCRP Regulatory Programs Complaint Form
Transporters of Waste Kitchen Grease
Online Registration
Promotional
Virginia’s Finest Program Application
Travel Clubs
Application for Registration Travel Clubs
(OCA-21)
Travel Club Bond
Template
(OCA-24)
Irrevocable Letter of Credit Travel Clubs
Template
(OCA-26)
Travel Club Fidelity Bond
Template
(OCA 25)
Virginia Travel Club Act
Additional Travel Club Registration Guidelines(OCA-23)
OCRP Regulatory Programs Complaint Form
Weights & Measures
Application for the Registration of Motor Fuels
Application for Weights and Measures Service Agency Certification — Taxi Companies
Application for Weights and Measures Service Agency Certification
Application for Weights and Measures Service Technician Certification
Motor Fuel Price Gouging Complaint Form
Registration Packet for Commission Merchants
Registration Packet for Cotton Handlers
Registration Packet for Service Agency and Service Technician
Virginia Public Weighmaster Law and Application