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<br /> N.C. DEPARTMENT OF AGRICULTURE RETURN THIS REPORT TO-.
<br /> Director
<br /> MEAT & POULTRY INSPECTION DIVISION N.C. Departrrent of Agriculture and consumer Services
<br /> Meat and Poultry Inspection Division
<br /> REGISTRATION OF POULTRY & MEAT HANDLERS Agriculture Building
<br /> 1001 Mail Service Center
<br /> Raleigh, North Carolina 27699-1001
<br /> i NAME AND MAILING ADDRESS OF REGISTRANT IIncluding ZIP Code) NOTICE OF REGISTRATION BY NGDA
<br /> REGIISTRATION NO. - _ DATE OF Rt;iISTAATION
<br /> 1/7/14
<br /> TITLE❑FNCOA 001CIAL SIGNATURE=DF NCDA DFFI IAL
<br /> The Community Farm at Chestnut Ridge State Director
<br /> ~4300 Camp Chestnut Ridge Road 2. FORM OF ORGANIZATION(Check)
<br /> Efland, N.C.27243
<br /> 1 1_i individually Owned
<br /> (Mailing Address) 2 1:1 Partnership
<br /> 3 I� Corporation chartered in State of North Carolina_
<br /> 4 ❑_ Cooperative Association
<br /> 6 LJ Other(Specify)
<br /> 3. NATURE OF BUSINESS
<br /> A. POULTRY OR POULTRY PRODUCTS dealers,etc. (Check as appropriate) YES NO
<br /> (1I Are you angaged in business iin or For commerce') as a poultry products broker, renderer, or animal food manufacturer;
<br /> or da you engage in business in commerce as a wholesaler of any carcasses, or parts or products of carcasses, of any
<br /> poultry, whether Intended for human food or other purposes;or do you engage in business as a public warehouseman
<br /> m ... ..
<br /> storing any stsclt articles in or for eorarce?................. .. ...................................................._..__................
<br /> I21 Are you engaged in the business of buying,selling, or transporting in commerce, or importing, any dead, dying,
<br /> disabled, or diseased animals of the kinds specified in item A(11 above, or parts of the carcasses of any such animds I 1 r
<br /> that died otherwise than by slaughw? .................................................................................................................. .._ ,
<br /> B. MEAT OR NEAT PRODUCTS dealers,etc. (Check as appropriate)
<br /> 11I Are you engaged in bustrwss fin or for commerce") as a meat broker,renderer, or animal food manufacturer;or are YTS NO
<br /> you engaged in business in commerce as a wholesaler of any carcasses,or parts or products of the carcasses,of any
<br /> cattle, sheep, svvine, goats,horses, mules, or equines, whether intended for human food or other purposes;or are you --
<br /> ongagad in business as a public warehouseman stbr+ng any such artictos in or for conmoroa? .....................................
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<br /> (2) Are you engaged in the business of buying,selling or transporting in cc,P,, rce or importing,any tiled,dying,
<br /> disabled, or diseased animals of the kinds specified in item B(1) above, or parts of the carcasses of any such animals r
<br /> that died otherwise than by slaughter?..................................,............................................................................... I•---1 I:_..I
<br /> 'Tha term'00 Mm On'a"means Commerce betw aen any State,any terrimry,or She District or Colum hia,and any place outside that ool;or within any Carr itory not
<br /> organized with a legislative body,or the Distrlct or Columbia.
<br /> 4. IF THE ANSW_E TO ANY OF THE CltlESTIONS IN rrEM 3 ABOVE IS"YES",COMPLETE THE FOLLOWING:
<br /> A. Name of your firrru and address(include ZIP B. Address{as) of subsidiades,hranches,or divisions of your organization which ^_
<br /> Code) if different from item 1. engage in business of the type identified in item B. Include trade or other nurses
<br /> if different from your organization's. (If none,so state.)
<br /> The Community Farm at Chestnut Ridge
<br /> 2902 Mt.Vlfllling Road
<br /> Efland, N.C.27243
<br /> (Physical Address)
<br /> Id1A
<br /> _..... .......... ......_. -_...................... . .. _ __..._.._.
<br /> C. Describe the goneraf nature of your own business. Also describe separately the nature of the business of your subsidiaries,if any, if
<br /> this is different from that of tha parent firm.
<br /> Meat and Poultry Handler:At the time of this review The Community Farm at Chestnut Ridge was given M.P.].D. Notice
<br /> 10-09 Labeling and Point of Purchase Claims and M.P,I.D. Notice 36-08 Meat and Poultry Requirements.
<br /> b. REMARKS
<br /> The establishment operates a farm and a camp for children (year around).They have a County Inspected kitchen located
<br /> In the Camp part of the property for the children staying at the Camp. The animals raised on the farm is being slaughtered
<br /> and processed at Key Packing Company and being stored at 2902 Mt.Willing Road, Efland, N.C.,this address is also
<br /> located on the same property as the Camp for the children.The establishment is fully aware that all meat and poultry
<br /> products picked up from any inspected establishment must contain a N.C.D.A. or U•S.D.A. mark of inspection.
<br /> CERTIFICATION CY FIRM
<br /> DATE TITLE TYPED OR PRINTED NAME SIGNATURE
<br /> 12/20/13 Ownerlgeratar Erica Romkema
<br /> Form MP-2
<br /> 63
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