OFFICE USE ONLY GAME AND FISH DEPARTMENT LICENSE #: DEAL IN LIVE BAITFISH APPLICATION FORM DATE : LICENSE FEE $69.00 INITIALS:

DEALER OF RECORD:

Last Name First Name Middle Initial Suffix

XXX-XX- Sportsperson I.D. Social Security Number Day Time Phone Number (Last 4 digits required)

Weight Sex Height (Ft — In) Eyes Hair

Business Establishment Name (if applicable) Date of Birth

Fish Holding Facility Address

City State Zip Code

Dealer Mailing Address if different from Fish Holding Facility Address

City State Zip Code

Night/Alternative Phone Number Email Address (optional)

Description of aquaria or fish holding facilities*

*If you selected A as the answer to the first question (shaded box) on the next page and one of the six wild caught fish areas (1, 2A, 3A, 5A, 5B or 5C), you must provide detailed descriptions of the separate aquaria or holding facilities to be used for hatchery produced and wild caught baitfish.

UNDER PENALTY OF PROSECUTION, I SWEAR THAT THE INFORMATION GIVEN BY ME ABOVE AND BELOW MY SIGNATURE IS TRUE AND CORRECT.

APPLICANT’S SIGNATURE______DATE______OR PARENT OR LEGAL GUARDIAN’S SIGNATURE______DATE______(If Applicant is under the age of 18)

Only certified check, cashier’s check, or money order will be accepted. Personal checks drawn on Wyoming banks will be accepted from Wyoming residents. No two party checks accepted. Live Baitfish Dealer licenses are issued at the Wyoming Game and Fish Department regional offices located in Jackson, Pinedale, Cody, Sheridan, Green River, Laramie, Lander, Casper and the headquarters office in Cheyenne.

Check this box only if you would like your e-mail address, year of birth, and telephone number made available as public informationRevised 09/2018 as per state law (W.S. § 23-1-706). Other Information given on application may be made available as public information, except as provided by law. Do you wish to sell fathead minnows from a Department Approved Fish Hatchery? Select A, B or C below.

A) Yes, I wish to buy or sell fathead minnows from Department Approved Fish Hatchery for use in Multiple Areas east of the continental divide where the use of live baitfish is permitted. Separate holding facilities required if also selling wild caught live baitfish. Use Multiple Area/Commercially Produced Live Baitfish Dealer Receipts. B) Yes, I wish to buy or sell fathead minnows from Department Approved Fish Hatchery for use only in the Single Area selected below. Separate holding facilities not required for wild caught live baitfish. Use Single Area/Wild Caught Live Baitfish Dealer Receipts.

C) No, I wish to buy or sell only wild caught live baitfish. Use Single Area/Wild Caught Live Baitfish Dealer Receipts.

Do you wish to buy or sell Wild Caught Live Baitfish? If “yes” you must select one of the six Area Location boxes below. If you selected “A” above and one of the Area Location boxes below (1, 2A, 3A, 5A, 5B or 5C), hatchery and wild caught minnows must be held in separate aquaria or fish holding facilities and separate records must be maintained for each facility. Dealing in live baitfish is prohibited in Areas 4 and 3C.

No Will buy or sell only hatchery produced live baitfish. Area 1 Live baitfish may be taken by seine, net, trap or spear from the following waters: Snake River drainage, excluding the waters within the National Parks and the John D. Rockefeller Jr. Memorial Parkway. Any baitfish captured except those to be held by live baitfish dealers shall be killed immediately. Baitfish permissible for use in the Snake River drainage are redside shiner, speckled dace, longnose dace, Paiute sculpin, mottled sculpin, Utah chub, Utah sucker and commercially preserved dead baitfish. Baitfish SHALL ONLY be used as DEAD BAIT wherever the use of baitfish is legal. Area 2; Location A Live baitfish may be taken by seine, net, trap or spear from the following waters: Wind River and Big Horn River drainages downstream from the western boundary of the Wind River Reservation. Live baitfish may be used only on the following waters: Wardell Reservoir, Big Horn Lake, Bighorn River, Deaver Reservoir, Harrington Reservoir, Shoshone River downstream from Penrose , Wind River downstream from Boysen Reservoir, Boysen Reservoir, Ocean Lake, and Pilot Butte Reservoir. Live baitfish restricted to use in location 2A SHALL NOT BE TRANSPORTED out of the Wind River and Bighorn River drainages downstream from the western boundary of the Wind River Reservation. Area 3; Location A Live baitfish may be taken by seine, net, trap, or spear from the following waters: Keyhole Reservoir and Belle Fourche River drainage. Live baitfish may be used only on the following waters: Keyhole Reservoir and Belle Fourche River proper. Live baitfish SHALL NOT BE TRANSPORTED out of the Belle Fourche River drainage, and the Little Powder River drainage upstream of the confluence of Cottonwood Creek in Campbell County. Area 5; Location A Live bait may be taken by seine, net, trap, or spear from the following waters: Bump Sullivan Reservoir, Festo Lake, Grayrocks Reservoir, Guernsey Reservoir, Hawk Springs Reservoir, proper from Glendo Dam downstream to the Wyoming-Nebraska state line, Packers Lake, Rock Lake, Springer Reservoir, Wheatland Reservoir #1, and canals and ditches within Wyoming that are in the Interstate and Fort Laramie canal systems in Goshen County and downstream from the Whalen Diversion on the North Platte River. Live baitfish may be used only on the 9 standing waters listed in the preceding sentence and the North Platte River proper from Glendo Dam downstream to the WY-NE state line. Live baitfish SHALL NOT BE TRANSPORTED out of the North Platte River drainage below Glendo Dam and shall not be possessed in the South Platte River drainage or in Albany County. Area 5; Location B Live baitfish may be taken by seine, net, trap, or spear from the following waters: North Platte River drainage from downstream to Glendo Dam. Live baitfish may be used only on the following waters: Pathfinder Reservoir, Alcova Reservoir, Gray Reef Reservoir, , Kortes Reservoir, Guernsey Reservoir, North Platte River proper between Seminoe Dam and Glendo Dam, except eight (8) river miles from Gray Reef Dam to the upstream boundary of the Lusby Public Fishing Area and from the vehicle bridge eight tenths (0.8) of a mile downstream from downstream to Alcova Reservoir. Live baitfish SHALL NOT BE TRANSPORTED out of the North Platte River drainage below Seminoe Dam downstream to Glendo Dam. Area 5; Location C Live baitfish may be taken by seine, net or trap or spear from the following waters: North Platte River drainage from I-80 downstream to Seminoe Dam. Live baitfish may be used only on the following waters: Seminoe Reservoir and North Platte River from Seminoe Reservoir to I-80. Live baitfish SHALL NOT BE TRANSPORTED out of the North Platte River drainage below Interstate Highway 80 downstream to Seminoe Dam.

All applicable regulations are NOT included on this form. Complete regulations can be found in Chapter 46, sections 6, 7 and 8 for complete baitfish or online at https://wgfd.wyo.gov/Fishing-and-Boating/Forms-and-Applications

Revised 09/2018