Halal Registration Form - Illinois Department of Agriculture

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APPENDIX D Disclosure Statement: RetailFor purposes of this disclosure, non-halal means food that this establishment does not represent to be halal.Name of Retail Establishment:Please check all that apply.A. General DisclosureThis establishment sells only halal foods.This establishment sells both halal and non-halal foods.This establishment sells only meat and poultry as halal.This establishment sells dairy goods as halal.This establishment sells bakery products as halal.This establishment makes no representation as to the halal status of its foods other than that whichappears on the package label of prepackaged food.Meat sold at this establishment is under the supervision of the following halal certifying entity:Name:Address:Telephone Number:Poultry sold at this establishment is under the supervision of the following halal certifying entity:Name:Address:Telephone Number:Dairy products sold at this establishment are under the supervision of the following halal certifyingentity:Name:Address:Telephone Number:Appendix D 1
Bakery goods sold at this establishment are under the supervision of the following halal certifyingentity:Name:Address:Telephone Number:This establishment uses separate utensils, cutting boards, machine slicers, meat grinders, knives andother equipment for halal and non-halal foods and the equipment is appropriately identified.This establishment uses separate refrigerators, freezers and storage areas for halal and non-halalfood.Non-halal food products are not mixed with halal food products.Appendix D 2
Page 5 and 6: APPENDIX B Disclosure Statement: Sl
Page 7 and 8: D. Post-SlaughterNo part of the pou
Page 9 and 10: B. Meat and PoultryMeat offered for
Page 11: This establishment purchases only m
Page 15 and 16: The poultry offered for sale at thi
Page 17 and 18: F. Food PackagingFood packaging mat
Page 19 and 20: B. Meat and PoultryMeat offered for
Page 21: C. Food PackagingMeat and poultry o

Halal Registration Form - Illinois Department of Agriculture

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