Halal Registration Form - Illinois Department of Agriculture

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C. Bakery ProductsThis establishment purchases only meat or poultry labeled halal or zabiha halal from a federallyinspected meat packaging plant.This establishment sells meat or poultry that has not been identified as halal or zabiha halal by theslaughterhouse.Pork or pork products are not sold at this establishment.Bakery products sold here do not contain any alcohol.Bakery products sold here do not contain any pork, animal fat or lard.Bakery products sold here do not contain any non-halal beef gelatin.Bakery products sold here contain only gelatin derived from plants.Bakery products sold here contain only gum derived from plants.D. Milk and Dairy ProductsAll cheese sold here is certified as halal.The name, address and telephone number of the halal certifying entity is:Name:Address:Telephone Number:All milk sold here is certified as halal.The name, address and telephone number of the halal certifying entity is:Name:Address:Telephone Number:E. Food Products Prepared On SitePrepared food labeled or represented as halal does not contain or use any ingredients from an animalnot represented as halal by the slaughterhouse.Prepared food labeled or represented as halal does not contain any product containing pork.Prepared food labeled or represented as halal does not contain any alcohol.No alcohol is used in the preparation of any prepared food represented as halal.Appendix D 5
F. Food PackagingFood packaging materials have been certified as halal by the following halal certifying entity:Name:Address:Telephone Number:G. Cleaners and SanitizersOnly non-animal derived/non-alcohol based cleansers and sanitizers are used to wash/clean theequipment.H. Certification by RetailerI certify that the above information is correct.SignaturePrinted NameBusiness NameAddressCity State Zip CodeTelephone NumberDateIL406-1693 (12-07)Appendix D 6
Page 5 and 6: APPENDIX B Disclosure Statement: Sl
Page 7 and 8: D. Post-SlaughterNo part of the pou
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Page 13 and 14: Bakery goods sold at this establish
Page 15: The poultry offered for sale at thi
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Halal Registration Form - Illinois Department of Agriculture

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