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9 : IOWA DEPARTMENT OF NATURAL RESOURCES
Licensing Section
502 East 9th Street, Des Moines, IA 50319-0034
(515) 725-8200 HYPERLINK "http://www.iowadnr.gov" www.iowadnr.govCASHIERS USE ONLY
0233-542-0092-LF-0570
Business Name
APPLICATION FOR GAME BREEDERS LICENSEIf completing online, please use the TAB key to navigate your way through this form. Do not press Enter.
APPLICANT INFORMATIONLast Name: FORMTEXT F i r s t N a m e : F O R M T E X T D a t e o f B i r t h : F O R M T E X T S o c i a l S e c u r i t y # * : F O R M T E X T P h o n e # : F O R M T E X T M a i l i n g A d d r e s s : F O R M T E X T C i t y : F O R M T E X T S t a t e : F O R M T E X T Z i p : F O R M T E X T E m a i l : F O R M T E X T C o u n t y : F O R M T E X T * T h e I o w a D e p a r t m e n t o f N a t u r a l R e s o u r c e s i s r e q u i r e d t o c o l l e c t s o c i a l s e c u r i t y n u m b e r s f r o m a l l p e r s o n s o b t a i n i n g a h u n t i n g , f i s h i n g , o r o t h e r r e c r e a t i o n a l l i c e n s e u n d e r s e c t i o n 2 5 2 J . 8 o f t h e 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 INFORMATIONBusiness Name: FORMTEXT B u s i n e s s M a i l i n g A d d r e s s : F O R M T E X T C i t y : F O R M T E X T S t a t e : F O R M T E X T Z i p : F O R M T E X T P h o n e # : F O R M T E X T A P P L I C A T I O N F O R : F O R M C H E C K B O X R e s i d e n t F e e - $ 2 0 . 0 0 F O R M C H E C K B O X N o n R e s i d e n t F ee- $32.50 - Your state MUST have reciprocity with Iowa.Threatened and Endangered SpeciesA complete list of state and federal threatened and endangered species can be found on the following web pages:
HYPERLINK "http://www.iowadnr.gov/Conservation/Iowas-Wildlife/Threatened-and-Endangered" \t "_blank" http://www.iowadnr.gov/Conservation/Iowas-Wildlife/Threatened-and-Endangered
HYPERLINK "https://www.fws.gov/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 ApplicantDate
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 HYPERLINK "http://www.iowadnr.gov/Hunting/Hunting-Licenses-Laws/License-Applications" http://www.iowadnr.gov/Hunting/Hunting-Licenses-Laws/License-Applications. Completed receipts and reports can be submitted electronically to HYPERLINK "mailto:Webmaster@dnr.iowa.gov" Webmaster@dnr.iowa.gov.
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. FORMCHECKBOX APPROVED
FORMCHECKBOX DISAPPROVEDOfficers SignatureDate
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 FORMCHECKBOX Coot FORMCHECKBOX Ruffed Grouse FORMCHECKBOX Mourning Dove FORMCHECKBOX Hooded Merganser FORMCHECKBOX Mallard FORMCHECKBOX Gray Partridge FORMCHECKBOX Wood Duck FORMCHECKBOX Chukar Partridge FORMCHECKBOX Redhead FORMCHECKBOX Pheasant FORMCHECKBOX Scaup FORMCHECKBOX Pigeon FORMCHECKBOX Pintail FORMCHECKBOX Bobwhite Quail FORMCHECKBOX Black Duck FORMCHECKBOX Sora FORMCHECKBOX Canvasback FORMCHECKBOX Virginia Rail FORMCHECKBOX Mottled Duck FORMCHECKBOX Snipe FORMCHECKBOX Snow Goose FORMCHECKBOX Trumpeter Swan FORMCHECKBOX Ross Goose FORMCHECKBOX Blue-wing Teal FORMCHECKBOX Canada Goose FORMCHECKBOX Green-wing Teal F O R M C H E C K B O X B r a n t G o o s e F O R M C H E C K B O X C i n n a m o n T e a l F O R M C H E C K B O X W h i t e - F r o n t e d G o o s e F O R M C H E C K B O X W i l d T u r k e y F O R M C H E C K B O X O t h e r ( s p e c i f y ) : F O R M T E X T F O R M C H E C K B O X W o o d c o c k
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This is an application and must be processed before the actual license can be issued.
06/2021 cmc PLEASE ALLOW 5-7 DAYS FOR PROCESSING DNR Form 542-1386
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