application for game breeder’s license
TRANSCRIPT
This is an application and must be processed before the actual license can be issued. 11/2018 cmc PLEASE ALLOW 5-7 DAYS FOR PROCESSING DNR Form 542-1386
IOWA DEPARTMENT OF NATURAL RESOURCES Licensing Section
502 East 9th
Street, Des Moines, IA 50319-0034 (515) 725-8200 www.iowadnr.gov
CASHIER’S USE ONLY 0233-542-0092-LF-0570 Business Name
APPLICATION FOR GAME BREEDER’S LICENSE If completing online, please use the “TAB” key to navigate your way through this form. Do not press Enter.
APPLICANT INFORMATION
Last Name: First Name:
Date of Birth: Social Security #*: Phone #:
Mailing Address:
City: State: Zip: County:
*The Iowa Department of Natural Resources is required to collect social security numbers from all persons obtaining a hunting, fishing, or other recreational license under section 252J.8 of the Code of Iowa and 42 US Code 666(a)(13). Your social security number will serve as your principal identification number to determine your eligibility for licenses. It will be provided to law enforcement agencies and the Iowa Child Support Collection Unit to establish, modify, and enforce child support obligations and to collect liabilities owed to the state or a state agency. It WILL NOT appear on your license.
BUSINESS INFORMATION
Business Name:
Business Mailing Address:
City: State: Zip: Phone #:
APPLICATION FOR:
Resident Fee- $20.00
Non Resident Fee- $32.50 - Your state MUST have reciprocity with Iowa.
THREATENED AND ENDANGERED SPECIES
A complete list of state and federal threatened and endangered species can be found on the following web pages:
http://www.iowadnr.gov/Conservation/Iowas-Wildlife/Threatened-and-Endangered https://www.fws.gov/endangered/
By signing below, I acknowledge that I have identified the specific species of fur-bearing animals, game animals, and game birds that I plan to possess, raise, and sell (see page 2 to identify species).
I acknowledge that this license does not allow me to possess, breed, propagate, sell, or dispose of any species which is defined as endangered or threatened under state or federal law.
I acknowledge and understand the rules and regulations regarding having this permit and realize that a State Conservation Officer may inspect my facility at any reasonable time. The Iowa game breeder laws can be found in Iowa Code Chapter 481A and the residency laws in Iowa Code Chapter 483A and Iowa Administrative Code Chapter 15.
Signature of Applicant Date
Failure to submit annual reports is a violation of law. Annual reports from the previous year must be received by January 31st
of the current license year and prior to this license being issued.
Annual report forms and receipts are located on our website at http://www.iowadnr.gov/Hunting/Hunting-Licenses-Laws/License-Applications. Completed receipts and reports can be submitted electronically to [email protected].
This is an application and must be processed before the actual license can be issued. 09/2017 cmc PLEASE ALLOW 5-7 DAYS FOR PROCESSING DNR Form 542-1386
All NEW applications must have the signature of the local State Conservation Officer before the license can be issued. All RENEWAL applicants that are not current must have the signature of the local State Conservation Officer before the license can be issued. APPROVED
DISAPPROVED Officer’s Signature Date
Identify the specific species of fur-bearing animals, game animals or game birds you plan to possess, raise, and sell: Check all that apply:
Game Birds
Coot Ruffed Grouse
Mourning Dove Hooded Merganser
Mallard Gray Partridge
Wood Duck Chukar Partridge
Redhead Pheasant
Scaup Pigeon
Pintail Bobwhite Quail
Black Duck Sora
Canvasback Virginia Rail
Mottled Duck Snipe
Snow Goose Trumpeter Swan
Ross’ Goose Blue-wing Teal
Canada Goose Green-wing Teal
Brant Goose Cinnamon Teal
White-Fronted Goose Wild Turkey
Other (specify): Woodcock
Game and Fur-Bearing Animals
Badger Opossum
Beaver Otter
Bobcat** Cottontail Rabbit
Coyote** Jackrabbit
Whitetail Deer Raccoon
Red Fox** Striped Skunk
Gray Fox** Gray Squirrel
Groundhog Fox Squirrel
Mink Weasel
Muskrat
Other (specify):
**Under Iowa law, a person cannot own, possess, breed, or transport a “dangerous wild animal” as that term is defined in Iowa Code chapter 717F. Several protected fur-bearers are included in that definition. Since 2007, no Iowa resident cay buy or obtain a “dangerous wild animal” to keep as a personal pet.