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2. Application for Cottage Food Industry Registration
   A cottage food operation allows for food that is not potentially hazardous such as baked goods, jams, jelly, preserves, fruit butter, dry herbs, dry herb blends or dry tea blends to be produced in the kitchen of a person’s primary domestic residence for direct sale to customers at a farmer’s market. Cottage food operation products cannot be sold to retail stores, restaurants, over the internet, by mail order, or to wholesale, brokers or other food distributors who resell food. Farmer’s market is defined as “common facility or areas where farmers gather to sell a variety of fresh fruits and vegetables and other locally produced farm and food products, directly to consumers”.
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5. To request placement of an alley light near your residence or business establishment, please fill out the below application.
7. Name of Business:
9. Owner Name(s):
11. Phone #:
12. Phone #:
14. Email:
16. Address:
17. City/State/Zip:
19. Address Where Food is Prepared (if different from above):
20. City/State/Zip:
22. FOOD SERVICE SANITATION MANAGER CERTIFICATION
24. Name:
25. ID Number (issued by IDPH):
27. Name:
28. ID Number (issued by IDPH):
30. OWNER’S STATEMENT
32. I, (Insert Name Below), agree to grant access to the local health department to conduct an inspection of my cottage food operation’s primary domestic residence in the event of a consumer complaint or foodborne illness outbreak.
34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
36. Electronic Signature*
37. Date:
39. Products:
    (Please indicate the items you will be making and selling)
41. Herbs (select all that apply):

    1. Dry Herb

    1. Dry Herb Blend

    1. Dry Tea Blend
43. Jam/Jelly/Preserves/Fruit Pie (select all that apply):

    1. Apple
    2. Apricot
    3. Grape
    4. Peach
    5. Plum

    1. Quince
    2. Orange
    3. Nectarine
    4. Tangerine

    1. Blackberry
    2. Raspberry
    3. Blueberry
    4. Boysenberry

    1. Cherry
    2. Cranberry
    3. Strawberry
    4. Red Currants
45. Fruit Butter (select all that apply):

    1. Apple
    2. Apricot

    1. Grape
    2. Peach

    1. Plum
    2. Quince

    1. Prune
47. Breads, Cookies, Cakes & Pastries (please list all items):
49. PRODUCT LABELING:
    Include a sample label with application. Label must meet the below requirements.
51. -The name and address of the cottage food operation
53. -The common or usual name of the food product
55. -All ingredients including colors, artificial flavors, preservatives, listed in decreasing order or prominence by weight
57. -Statement: “The product was produced in a home kitchen and not subject to public health inspection that may also process common food allergens.”
59. -The date the product was processed
61. -Allergen labeling as specified in federal labeling requirements
    Click here to review requirements
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63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

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