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 9 th 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 31 st 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].