ADMINISTRATIVE CODE

TITLE 8: AGRICULTURE AND ANIMALS
CHAPTER I: DEPARTMENT OF AGRICULTURE
SUBCHAPTER b: ANIMALS AND ANIMAL PRODUCTS (EXCEPT MEAT AND POULTRY INSPECTION ACT REGULATIONS)
PART 190 HALAL FOOD DISCLOSURE

Section 190.10 Definitions

Section 190.20 Registration Requirements; Posting of Registration

Section 190.30 Labeling Requirements

Section 190.40 Disclosure Statement Requirements; Posting of Disclosure Statement

Section 190.50 Record Keeping Requirements

Section 190.60 Record Availability

Section 190.70 Humane Methods of Slaughter

Section 190.80 Halal Food Act

Section 190.90 Meat and Poultry Inspection Act

Section 190.100 Unlawful Practice

Section 190.APPENDIX A Disclosure Statement: Slaughterhouse - Cattle, Goats, Sheep and Lambs

Section 190.APPENDIX B Disclosure Statement: Slaughterhouse - Poultry

Section 190.APPENDIX C Disclosure Statement: Distributor

Section 190.APPENDIX D Disclosure Statement: Retail

Section 190.APPENDIX E Disclosure Statement: Restaurant, Nursing Home, Summer Camp, Caterer or Other Dealer Who Serves Prepared Food

AUTHORITY: Implementing and authorized by Section 2LL of the Consumer Fraud and Deceptive Business Practices Act [815 ILCS 505/2LL].

SOURCE: Adopted at 31 Ill. Reg. 16443, effective December 1, 2007.

Section 190.10 Definitions

"Act" means the Consumer Fraud and Deceptive Business Practices Act [815 ILCS 505].

"Certifying Entity" means a certifying Islamic entity specializing in halal food or the supervising Muslim Inspector of Halal Food.

"Dealer" means any establishment that advertises, represents, or holds itself out as growing animals in a halal way or selling, preparing, or maintaining food as halal, including, but not limited to, manufacturers, animal farms, slaughterhouses, wholesalers, stores, restaurants, hotels, catering facilities, butcher shops, summer camps, bakeries, delicatessens, supermarkets, grocery stores, licensed health care facilities, freezer dealers, and food plan companies. These establishments may also sell, prepare or maintain food not represented as halal.

"Department" or "IDOA" means the Illinois Department of Agriculture.

"Director" means the Director of the Department.

"Distributor" means any person, firm or corporation engaged in the business of buying, negotiating for purchase of, handling or taking possession of, or selling products on commission or otherwise purchasing or selling of such articles other than for the person's own account.

"Food" means an animal grown to become food for human consumption, a food, a food product, a food ingredient, a dietary supplement, or a beverage.

"Halal" means prepared under and maintained in strict compliance with the laws and customs of the Islamic religion, including but not limited to those laws and customs of the zabiha/zebeeha (slaughtered according to appropriate Islamic codes) and as expressed by reliable recognized Islamic entities and scholars. [815 ILCS 505/2LL(a)]

Section 190.20 Registration Requirements; Posting of Registration

a) No dealer may represent an animal to be grown in a halal way to become food for human consumption or a food commodity as halal until the dealer has registered with the Department.

b) Dealers shall register on forms prescribed by the Department. Registration shall be valid until June 30 of each year. Each location of a dealer shall be separately registered. All dealers shall pay to the Department at the time of registration a $75 registration fee.

c) The following information is required for dealer registration: business name, address, and phone number. In addition, the dealer shall provide information disclosing the certifying entity, including the name, address, and phone number of the certifying entity, and a completed disclosure statement as provided in Section 190.40. The dealer must sign the registration form and certify that: "All food labeled halal is kept in the halal way and is from halal sources."

d) If the information required on a registration form changes during a year, then the dealer shall file an amended registration form.

e) A dealer shall post a copy of its registration form filed with the Department in a conspicuous place readily visible to customers.

Section 190.30 Labeling Requirements

a) A dealer shall not sell or distribute halal food unless such food is plainly labeled with the word "HALAL". No person shall deface, erase or remove any label required by this Section.

b) Any halal marking applied to red meat carcasses and/or poultry from animals represented as grown and slaughtered in the halal way shall be visible and readable.

c) A dealer may not sell, offer for sale, prepare, or service in or from the same place of business both unpackaged non-halal food and unpackaged food that he or she represents to be halal unless he or she posts a window sign at the entrance of his or her establishment that states in block letters at least 4 inches in height: "Halal and Non-Halal Foods Sold Here" or "Halal and Non-Halal Foods Served Here" or a statement of similar import.

Section 190.40 Disclosure Statement Requirements; Posting of Disclosure Statement

a) A dealer shall request from the Department the disclosure statements applicable to the business (see Appendices A-E). When making a request, the dealer shall identify its business type as (or a combination of) the following:

1) Slaughterhouse − Cattle, goats, sheep, and lambs (Appendix A);

2) Slaughterhouse − Poultry (Appendix B);

3) Distributor (Appendix C)

4) Retail establishment (Appendix D); and

5) All other establishments that advertise, represent, or hold themselves out as selling, preparing, or maintaining food as halal, including, but not limited to, manufacturers, wholesalers, restaurants, hotels, catering facilities, summer camps, bakeries, delicatessens, licensed health care facilities, freezer dealers, and food plan companies (Appendix E).

b) A dealer shall have copies of the disclosure statements filed with the Department in a public place, readily accessible to customers.

c) A dealer shall post in a conspicuous place the name and address of the distributor or slaughter facility of all meat and poultry products sold on the premises.

d) In the event of any change in the practices reported to the Department on the halal disclosure statement, a dealer shall immediately manually amend its posted halal disclosure statement to reflect the change in the posted practices and shall inform the Department in writing and, if applicable, any party to a contract, within 14 calendar days after any change in the stated information. The Department shall provide the dealer with a new halal disclosure statement form. The dealer shall complete and return the new halal statement to the Department within 14 calendar days. A dealer shall have a copy of the amended disclosure statement in a public place, readily accessible to customers.

Section 190.50 Record Keeping Requirements

a) Dealers shall maintain records evidencing sales, purchases, or other transfers of halal animals or food for 2 years from the date of sale, purchase or transfer. The records shall contain the date of the transaction, the type of halal food involved in the transaction, the parties to the transaction and copies of the disclosure statements.

b) Dealers shall maintain copies of disclosure forms that certify the dealer's food or animals to be halal as provided by a certifying entity for two years from the date of sale, purchase or transfer. Copies of the disclosure statements shall accompany products with each sale.

Section 190.60 Record Availability

Upon request, a dealer shall provide to the Director or the Director's designee copies of any records maintained under this Part. Failure of a dealer to comply with the Director's or designee's request for records is prima facie evidence that the dealer has violated this Part.

Section 190.70 Humane Methods of Slaughter

Nothing in this Part shall be construed to exempt any dealer from any of the provisions of the federal Humane Methods of Slaughter Act of 1978 (7 USC 1901) or the Illinois Humane Slaughter of Livestock Act [510 ILCS 75] that may be applicable.

Section 190.80 Halal Food Act

Nothing in this Part shall be construed to exempt any dealer from any of the provisions of the Halal Food Act [410 ILCS 637] that may be applicable.

Section 190.90 Meat and Poultry Inspection Act

Nothing in this Part shall be construed to exempt any meat and/or poultry product from any of the provisions of the Meat and Poultry Inspection Act [225 ILCS 650] that may be applicable.

Section 190.100 Unlawful Practice

a) It shall be an unlawful practice under the Act for any person to violate this Part. The Department shall refer any alleged violations of this Part to the Attorney General.

b) Any person subject to the requirements of Section 190.40 does not commit an unlawful practice if the person shows by a preponderance of the evidence that the person relied in good faith upon the representations of the animal farm, slaughterhouse, manufacturer, processor, packer, or distributor of any food represented as halal. [815 ILCS 505/2LL(c)]

c) Possession by a dealer of any food not in conformance with Section 190.40 with respect to that food is presumptive evidence that the person is in possession of that food with the intent to sell. [815 ILCS 505/2LL(d)]

Section 190.APPENDIX A Disclosure Statement: Slaughterhouse − Cattle, Goats, Sheep and Lambs

Name of Slaughterhouse:

Please check all that apply.

A. Raising of Animals

	This establishment slaughters only cattle, goats, sheep and lambs that have only been fed feed that does not contain animal by-products, such as 100% vegetarian feed, organic feed or Amish feed.
	The cattle, goats, sheep and lambs are free from diseases and raised without added hormones.
	The cattle, goats, sheep and lambs slaughtered here do not have any sub-therapeutic antibiotics in their system at the time of slaughter.

B. Origin of Animals Slaughtered

	Animals are raised on the premises.
	USDA premises ID number:

Animals are purchased from the following farms (include the USDA Premise ID Number):

Name		ID #

	Animals are purchased from the following auctions:

C. Slaughter

The USDA Plant Number of this slaughterhouse is:
The Illinois Department of Agriculture plant number of this slaughterhouse is:

	The slaughterhouse is not under the supervision of any halal certifying entity.
	The slaughterhouse is under the supervision of the following halal certifying entity.
	Name of Certifying Entity:
	Address:

The slaughter of animals is performed in the following manner:

	The animal is alive at the time of slaughter.
	The animal is not stunned before slaughter.
	The animal is slaughtered with a sharp knife.
	The knife used during the slaughter is cleaned/sanitized after each animal.
	The animal is facing Mecca when slaughtered.
	The animal is slaughtered by a person who represents him/herself as a Muslim.
	Name:
	Certifying entity:
	The slaughterer pronounces an Islamic benediction while performing the slaughter.
	The animal is slaughtered with a swift, deep, transverse incision on the neck that causes a simultaneous and instantaneous severance of the jugular veins and carotid arteries on both sides, including the trachea and esophagus.
	The spinal cord is not severed at the time of slaughter.
	If any additional steps or procedures are performed, they are:




	Pigs are slaughtered in this slaughterhouse.

	If the above box is checked, answer the following:
		Pigs are slaughtered on separate equipment.
		Pigs are slaughtered on the same day as animals that are slaughtered to be sold as halal.
		Pigs are slaughtered on a different day than animals that are slaughtered to be sold as halal.

D. Post-Slaughter

	No part of the animal is cut before the animal is completely dead.
	Only non-animal derived/non-alcohol based cleansers and sanitizers are used to wash/clean the equipment.
	The animal is drained of blood following the slaughter.
	The animal slaughtered to be sold as halal is stored in a cooler or freezer that contains only meat or poultry to be sold as halal.
	Animals are labeled as halal or zabiha halal consistent with the Food Standards and Labeling Policy Book of the USDA.
	If the slaughterhouse fabricates meat to be sold as halal, food packaging materials have been certified as halal by a halal certifying entity.
	If the slaughterhouse fabricates meat to be sold as halal, the meat has not been co-mingled with any food or food product not represented to be halal.

E. Certification by Slaughterhouse

I certify that the above information is correct.


Signature
Printed Name
Business Name
Address
City		State	Zip Code
Telephone Number	Date

Section 190.APPENDIX B Disclosure Statement: Slaughterhouse − Poultry

Name of Poultry Slaughterhouse:

Please check all that apply.

A. Raising of Poultry

	This establishment slaughters only poultry that have been fed feed that does not contain any animal or animal by-products, such as 100% vegetarian feed, organic feed or Amish feed or seafood.
	This establishment slaughters only poultry that has been raised on free roaming farms.
	The poultry are free from diseases and raised without added hormones.
	The poultry slaughtered do not have any sub-therapeutic antibiotics in their system at the time of slaughter.

B. Origin of Poultry Slaughtered

	Poultry are raised on the premises.
	USDA Premises ID number:

Poultry is purchased from the following farms (include the USDA Premises ID number):

Name		ID #

	Poultry is purchased from the following auctions:

C. Slaughter

The USDA Plant Number of this slaughterhouse is:

The IDOA plant number of this slaughterhouse is:

	The slaughterhouse is not under the supervision of any halal certifying entity.
	The slaughterhouse is under the supervision of the following halal certifying entity.
	Name of Certifying Entity:
	Address:

The slaughter of poultry is performed in the following manner:

	If the poultry is hand-slaughtered with a sharp knife:
	If the above box is checked, answer the following:
			The poultry is alive at the time of slaughter.
			The poultry is not stunned before slaughter.
			The knife used during the slaughter is cleaned/sanitized after each use.
			The poultry is facing Mecca when slaughtered.
			The poultry is slaughtered by a person who represents him/herself as a Muslim.
			The slaughterer pronounces an Islamic benediction while performing the slaughter.
			The poultry is slaughtered with a swift, deep, transverse incision on the neck that causes a simultaneous and instantaneous severance of the jugular veins and carotid arteries on both sides, including the trachea and esophagus.
			The spinal cord is not severed at the time of slaughter.

If the poultry is slaughtered by mechanical means:
	If the above box is checked, answer the following:
			The poultry is alive at the time of slaughter.
			The poultry is not stunned before slaughter.
			The poultry is facing Mecca when slaughtered.
			The machine is turned on and supervised by a person who represents him/herself as a Muslim.
			An Islamic benediction is pronounced when the machine is turned on.
		The poultry is slaughtered with a swift, deep incision on the neck that cuts the jugular veins and carotid arteries on both sides and also the trachea and esophagus.
		Poultry that are not adequately slaughtered by the machine are manually slaughtered by a person who represents him/herself as a Muslim slaughterer with Islamic benediction.
		The poultry is not decapitated.
		If any additional steps or procedures are performed, they are:

Pigs are slaughtered in this slaughterhouse.

If the above box is checked, answer the following:

	Pigs are slaughtered on separate equipment.
	Pigs are slaughtered on the same day as animals that are slaughtered to be sold as halal.
	Pigs are slaughtered on a different day as animals that are slaughtered to be sold as halal.

D. Post-Slaughter

	No part of the poultry is cut before the poultry is completely dead.
	Only non-animal derived/non-alcohol based cleansers and sanitizers are used to wash/clean the equipment.
	The poultry is drained of blood following the slaughter.
	The poultry slaughtered to be sold as halal is stored in a cooler or freezer that contains only meat or poultry to be sold as halal.
	Poultry is labeled as halal or zabiha halal consistent with the Food Standards and Labeling Policy Book of the USDA.
	If the slaughterhouse fabricates poultry to be sold as halal, food packaging materials have been certified as halal by a halal certifying entity.
	If the slaughterhouse fabricates poultry to be sold as halal, the poultry has not been co-mingled with any food or food product not represented to be halal.

E. Certification by Slaughterhouse

I certify that the above information is correct.


Signature
Printed Name
Business Name
Address
City		State	Zip Code
Telephone Number	Date

Section 190.APPENDIX C Disclosure Statement: Distributor

For purposes of this disclosure, non-halal means food that this establishment does not represent to be halal.

Name of Distributor:

Please check all that apply.

A. General Disclosure

	This establishment distributes only halal foods.
	This establishment distributes both halal and non-halal foods.
	This establishment distributes only meat and poultry as halal.
	This establishment makes no representation as to the halal status of its foods other than that which appears on the package label of prepackaged food.
	Meat distributed at this establishment is kept in the original package.
	Meat distributed at this establishment is repackaged.
	Meat repackaged at this establishment may be from different sources.
	This establishment is under the supervision of the following halal certifying entity:
	Name:
	Address:

	Telephone Number:

B. Meat and Poultry

Meat offered for sale at this establishment has been purchased from the vendors listed below who made the following representations. Each vendor must have Part B (Meat) filled out individually:

Name:
Address:

Telephone Number:
IDOA halal registration number (if applicable):

	The animal was fed only 100% vegetarian feed, organic feed, or Amish feed, none of which contain any animal by-products.
	The animal was not treated with hormones.
	The animal was alive at the time of slaughter.
	The animal was not stunned before slaughter.
	The animal was hand-slaughtered with a sharp knife.
	The knife used during the slaughter was sharpened/cleaned after each animal.
	The animal was facing Mecca when slaughtered.
	The animal was slaughtered by a person who represents him/herself as a Muslim.
	The slaughterer pronounced an Islamic benediction while performing the slaughter.
	The animal was slaughtered with a swift, deep incision on the neck that cut the jugular veins and carotid arteries on both sides and also the trachea and esophagus.
	The spinal cord was not severed at the time of slaughter.
	Only non-animal derived/non-alcohol based cleansers and sanitizers were used to wash/clean the equipment.
	The animal was drained of blood following slaughter.
	The animal slaughtered to be sold as halal was stored in a cooler or freezer that contained only meat or poultry to be sold as halal.
	If any additional steps or procedures were performed, they were:




	This establishment distributes meat or poultry labeled halal or zabiha halal from a federally inspected meat packaging plant.
	This establishment distributes meat or poultry that has not been identified as halal or zabiha halal by the slaughterhouse.
	Pork or pork products are not sold at this establishment.

Poultry offered for sale at this establishment has been purchased from the vendors listed below who made the following representations. Each vendor must have Part B (Poultry) filled out individually:

Name:
Address:

Telephone Number:
IDOA halal registration number (if applicable):

	The poultry was fed only 100% vegetarian feed, organic feed, or Amish feed, none of which contain any animal by-products.
	The poultry was not treated with hormones.
	The poultry was alive at the time of slaughter.
	The poultry was not stunned before slaughter.
	The poultry was slaughtered by mechanical means.
	The poultry was hand-slaughtered with a sharp knife.
	The knife used during the slaughter was sharpened/cleaned after each use.
	The poultry was facing Mecca when slaughtered.
	The poultry was slaughtered by a person who represents him/herself as a Muslim.
	The slaughterer pronounced an Islamic benediction while performing the slaughter.
	The poultry was slaughtered with a swift, deep incision on the neck that cut the jugular veins and carotid arteries on both sides and also the trachea and esophagus.
	The spinal cord was not severed at the time of slaughter.
	Only non-animal derived/non-alcohol based cleansers and sanitizers were used to wash/clean the equipment.
	The poultry was drained of blood following slaughter.
	The poultry slaughtered to be sold as halal was stored in a cooler or freezer that contained only meat or poultry to be sold as halal.
	If any additional steps or procedures were performed, they were:




	This establishment purchases only meat or poultry labeled halal or zabiha halal from a federally inspected meat packaging plant.
	This establishment sells meat or poultry that has not been identified as halal or zabiha halal by the slaughterhouse.
	Pork or pork products are not sold at this establishment.

C. Food Products Prepared On Site

	Prepared food labeled or represented as halal does not contain or use any ingredients from an animal not 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.

D. Food Packaging

	Food packaging materials have been certified as halal by the following halal certifying entity:
	Name:
	Address:

	Telephone Number:

E. Cleaners and Sanitizers

Only non-animal derived/non-alcohol based cleansers and sanitizers are used to wash/clean the equipment.

F. Certification by Livestock Producer

I certify that the above information is correct.


Signature
Printed Name
Business Name
Address
City		State	Zip Code
Telephone Number	Date

Section 190.APPENDIX D Disclosure Statement: Retail

For 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 Disclosure

	This 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 which appears 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 certifying entity:
	Name:
	Address:

	Telephone Number:

	Bakery goods sold at this establishment are under the supervision of the following halal certifying entity:
	Name:
	Address:

	Telephone Number:

	This establishment uses separate utensils, cutting boards, machine slicers, meat grinders, knives and other 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-halal food.
	Non-halal food products are not mixed with halal food products.

B. Meat and Poultry

Meat offered for sale at this establishment has been purchased from the vendors listed below who made the following representations. Each vendor must have Part B (Meat) filled out individually:

Name:
Address:

Telephone Number:
IDOA halal registration number (if applicable):

	The animal was fed only 100% vegetarian feed, organic feed or Amish feed, none of which contains any animal by-products.
	The animal was raised without added hormones.
	The animal was alive at the time of slaughter.
	The animal was not stunned before slaughter.
	The animal was hand-slaughtered with a sharp knife.
	The knife used during the slaughter was cleaned/sanitized after each animal.
	The animal was facing Mecca when slaughtered.
	The animal was slaughtered by a person who represents him/herself as a Muslim.
	The slaughterer pronounced an Islamic benediction while performing the slaughter.
	The animal was slaughtered with a swift, deep, transverse incision on the neck that causes a simultaneous and instantaneous severance of the jugular veins and carotid arteries on both sides, including the trachea and esophagus.
	The spinal cord was not severed at the time of slaughter.
	Only non-animal derived/non-alcohol based cleansers and sanitizers were used to wash/clean the equipment.
	The animal was drained of blood following the slaughter.
	The animal slaughtered to be sold as halal was stored in a cooler or freezer that contains only meat or poultry to be sold as halal.
	If any additional steps or procedures were performed, they were:

The poultry offered for sale at this establishment has been purchased from the vendors listed below who made the following representations. Each vendor must have Part B (Poultry) filled out individually:

	The name, address and telephone number of the vendors from whom the poultry referred to above was purchased:
	Name:
	Address:

	Telephone Number:
	IDOA halal registration number (if applicable):

	The poultry was fed only 100% vegetarian feed, organic feed or Amish feed, none of which contain any animal by-products.
	The poultry was raised without added hormones.
	The poultry was alive at the time of slaughter.
	The poultry was not stunned before slaughter.
	The poultry was slaughtered by mechanical means.
	The poultry was hand-slaughtered with a sharp knife.
	The knife used during the slaughter was cleaned/sanitized after each use.
	The poultry was facing Mecca when slaughtered.
	The poultry was slaughtered by a person who represents him/herself as a Muslim.
	The slaughterer pronounced an Islamic benediction while performing the slaughter.
	The animal was slaughtered with a swift, deep incision on the neck that cut the jugular veins and carotid arteries on both sides and also the trachea and esophagus.
	The spinal cord was not severed at the time of slaughter.
	Only non-animal derived/non-alcohol based cleansers and sanitizers were used to wash/clean the equipment.
	The poultry was drained of blood following the slaughter.
	The poultry slaughtered to be sold as halal was stored in a cooler or freezer that contains only meat or poultry to be sold as halal.
	If any additional steps or procedures were performed, they were:

	This establishment purchases only meat or poultry labeled halal or zabiha halal from a federally inspected meat packaging plant.
	This establishment sells meat or poultry that has not been identified as halal or zabiha halal by the slaughterhouse.
	Pork or pork products are not sold at this establishment.

C. Bakery Products

	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 Products

	All 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 Site

	Prepared food labeled or represented as halal does not contain or use any ingredients from an animal not 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.

F. Food Packaging

Food packaging materials have been certified as halal by the following halal certifying entity:

Name:
Address:

Telephone Number:

G. Cleaners and Sanitizers

Only non-animal derived/non-alcohol based cleansers and sanitizers are used to wash/clean the equipment.

H. Certification by Retailer

I certify that the above information is correct.


Signature
Printed Name
Business Name
Address
City		State	Zip Code
Telephone Number	Date

Section 190.APPENDIX E Disclosure Statement: Restaurant, Nursing Home, Summer Camp, Caterer or Other Dealer Who Serves Prepared Food

Name of Restaurant, Nursing Home, Summer Camp, Caterer or Other Dealer:

Please check all that apply.

A. General Disclosures

	This establishment sells only food represented as halal as described in this disclosure statement.
	This establishment sells both food represented as halal and food not represented as halal.
	The restaurant, nursing home, summer camp, caterer or other dealer is not under the supervision of a halal certifying entity.
	The restaurant, nursing home, summer camp, caterer or other dealer is under the supervision of the following halal certifying entity.
	Name of Certifying Entity:
	Address:

	All food sold does not contain pork or pork products.
	All food sold does not contain blood as an ingredient.
	All food sold does not contain alcohol.
	All cheese used is certified as halal.
	All milk used is certified as halal.
	This establishment uses separate utensils, cutting boards, cooking utensils, ovens, microwaves and knives for halal and non-halal foods, which are appropriately identified.
	This establishment uses separate refrigerators, freezers and storage areas for food represented as halal and food not represented as halal.
	All food served as halal is not mixed with any non-halal food.
	Alcohol is not used in the preparation of food.

B. Meat and Poultry

Meat offered for sale at this establishment has been purchased from the vendors listed below who made the following representations. Each vendor must have Part B (Meat) filled out individually:

	The name, address and telephone number of the vendors from whom the meat referred to above was purchased:
	Name:
	Address:

	Telephone Number:
	IDOA halal registration number (if applicable):

	The animal was fed only 100% vegetarian feed, organic feed or Amish feed, none of which contains any animal by-products.
	The animal was raised without added hormones.
	The animal was alive at the time of slaughter.
	The animal was not stunned before slaughter.
	The animal was hand-slaughtered with a sharp knife.
	The knife used during the slaughter was cleaned/sanitized after each animal.
	The animal was facing Mecca when slaughtered.
	The animal was slaughtered by a person who represents him/herself as a Muslim.
	The slaughterer pronounced an Islamic benediction while performing the slaughter.
	The animal was slaughtered with a swift, deep, transverse incision on the neck that causes a simultaneous and instantaneous severance of the jugular veins and carotid arteries on both sides, including the trachea and esophagus.
	The spinal cord was not severed at the time of slaughter.
	Only non-animal derived/non-alcohol based cleansers and sanitizers were used to wash/clean the equipment.
	The animal was drained of blood following the slaughter.
	The animal slaughtered to be sold as halal was stored in a cooler or freezer that contains only meat or poultry to be sold as halal.
	If any additional steps or procedures were performed, they were:

	The name, address and telephone number of the vendors from whom the meat referred to above was purchased:
	Name:
	Address:

	Telephone Number:
	IDOA halal registration number (if applicable):

	The poultry was fed only 100% vegetarian feed, organic feed or Amish feed, none of which contains any animal by-products.
	The poultry was raised without added hormones.
	The poultry was alive at the time of slaughter.
	The poultry was not stunned before slaughter.
	The poultry was slaughtered by mechanical means.
	The poultry was hand-slaughtered with a sharp knife.
	The knife used during the slaughter was cleaned/sanitized after each use.
	The poultry was facing Mecca when slaughtered.
	The poultry was slaughtered by a person who represents him/herself as a Muslim.
	The slaughterer pronounced an Islamic benediction while performing the slaughter.
	The poultry was slaughtered with a swift, deep, transverse incision on the neck that causes a simultaneous and instantaneous severance of the jugular veins and carotid arteries on both sides, including the trachea and esophagus.
	The spinal cord was not severed at the time of slaughter.
	Only non-animal derived/non-alcohol based cleansers and sanitizers were used to wash/clean the equipment.
	The poultry was drained of blood following the slaughter.
	The poultry slaughtered to be sold as halal was stored in a cooler or freezer that contains only meat or poultry to be sold as halal.
	If any additional steps or procedures were performed, they were:

	Meat and poultry offered for sale have been slaughtered as halal or zabiha halal and identified as such at the slaughterhouse consistent with Federal labeling guidelines.
	This establishment purchases only meat or poultry labeled halal or zabiha halal from a federally or State inspected meat packing plant.
	Pork or pork products are not sold at this establishment.
	This establishment sells meat or poultry that has not been identified as halal or zabiha halal by the slaughterhouse.

C. Food Packaging

	Food packaging materials have been certified as halal by the following halal certifying entity:
	Name:
	Address:

	Telephone Number:

D. Cleaners and Sanitizers

Only non-animal derived/non-alcohol based cleansers and sanitizers are used to wash/clean the equipment.

E. Certification by Establishment

I certify that the above information is correct.


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