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BUREAU OF OCCUPATIONAL AND INDUSTRIAL SAFETY

HARRISBURG, PA 17120
Tel: 717-787-6848
Fax: 717-787-6925
www.dli.state.pa.us

APPLICATION FOR PENNSYLVANIA TOY REGISTRATION


We herewith make application for registration of the below named firm as:
(Circle one) Manufacturer
Importer
Craftsperson
FIRM NAME ________________________________________________________
ADDRESS __________________________________________________________
CITY _____________________ STATE ________ ZIP CODE ________ -_______
CONTACT PERSON _________________________________________________
TYPE OF TOYS MANUFACTURED_____________________________________
SIGNATURE _______________ NAME & TITLE __________________________
( PLEASE PRINT )

PHONE ( ____ ) ____________________ DATE

__________________________

FAX ( ___ ) ______________ FEDERAL ID NUMBER _____ - _____________


E-MAIL _____________________________________________________________
IMPORTERS NOTE:
NAME OF FOREIGN MANUFACTURER _________________________________
CITY ______________________ COUNTRY _______________________________
(PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS)
THE FOLLOWING OPTIONS FOR REGISTRATION ARE AVAILABLE TO FOREIGN
MANUFACTURERS:
1.

The manufacturer may register directly with the Department at the foreign manufacturers
location. This is identical to the requirement for domestic manufacturers, or

2.

An importer may hold a stuffed toy registration on behalf of each foreign manufacturer
represented. Please note that the importer is required to hold a separate registration for each
foreign manufacturer represented. The Department does not permit pooling of registrations.

When an importer holds the registration on behalf of the foreign manufacturer, the registration certificate
will show the name of both the importer and foreign manufacturer.
________________________________________________________________________________________________
LIBU-35 I REV 05 / 01 COMMONWEALTH OF PENNSYLVANIA DEPT. OF LABOR INDUSTRY PAGE 1 OF 4

A FEE OF TWENTY-FIVE DOLLARS ($25.00) SHALL ACCOMPANY EACH REGISTRATION

A craftsperson whose gross income from the sale of stuffed toys is less than $1,000.00 per
year is exempt from payment.
SUBMIT A SEPARATE CHECK WITH EACH APPLICATION

PLEASE TAKE NOTE! SAMPLE TOYS WHICH HAVE BEEN SELECTED AT RANDOM
FROM THOSE BEING OFFERED FOR SALE MUST ACCOMPANY THE NOTARIZED
AFFIDAVIT AND APPLICATION FOR REGISTRATION

Please make all checks payable to Department of Labor & Industry,


(US funds only). Mail to: Dept. of Labor & Industry, Bedding & Uph.,
Room 1619 7th & Forster Streets Harrisburg PA USA 17120-0019
Tel Number: (717) 787-6848

Fax Number: (717) 787-6925

QUESTIONS MAY BE DIRECTED TO THIS OFFICE BY TELEPHONE OR FAX

NOTE: PARAGRAPH (C) OF SECTION 47.314 OF PENNSYLVANIA CODE,


TITLE 34, READS:
Within 15 days after any change in or concerning a toy which makes the information
previously submitted with respect to it erroneous or inaccurate in any respect or within 15
days of commencement of a new toy as to which information has not been previously
submitted, the manufactured or importer shall submit to the Department the information
required by Subsection (a) of this Section concerning such new or changed toys.
See Affidavit
LIBU-35 I REV 05 / 01

COMMONWEALTH OF PENNSYLVANIA DEPT. OF LABOR & INDUSTRY Page 2 of 4

AFFIDAVIT
This page completed by Notary.
FOREIGN COUNTRIES WITHOUT NOTARIES, PLEASE COMPLETE AND SIGN FORM
In the matter of the Application of (Company Name)
_______________________________________________________________________
for Registration as a:

(Circle one)

Manufacturer

STATE OF

COUNTY OF

Importer

Craftsperson

___________________________________________, being duly sworn deposes and says:

(PLEASE SELECT ONE OF THE BELOW SELECTIONS)

(For corporation) He/She is the ______________________ of ___________________________;


(TITLE)

(COMPANY NAME)

(For partnership) He/She is a partner in the firm of ____________________________________;

(For individual) He/She is doing business under the firm name and style of
______________________________________;
(COMPANY NAME)

(For craftsperson) He/She is doing business under the name of ___________________________;


and makes stuffed toys as a leisure pursuit and whose gross income from the sale of these
products will be less than $1,000.00 per year.

__________________________________________________________________________
LIBU-35 I REV 05 / 01 COMMONWEALTH OF PENNSYLVANIA

DEPT. OF LABOR & INDUSTRY PAGE 3 OF 4

AFFIDAVIT
This page completed by Notary.

The samples submitted in connection with said application have been


selected at random from the products offered for sale by said applicant and
contain a representative sample of all coverings, component parts, and each
type of stuffing, filling or material incorporated as filling or stuffing in the
stuffed toys manufactured by applicant.

__________________________________________________
(SIGNATURE AND TITLE OF PERSON SIGNING)

Sworn to before me this _________________________

SEAL

day of ___________________________________________
______________________________________________________

Notary Public in and for said


county and state

LIBU-35 I REV 05 / 01 COMMONWEALTH OF PENNSYLVANIA DEPT. OF LABOR & INDUSTRY

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