IOWA DEPARTMENT OF NATURAL RESOURCES CASHIER’S USE ONLY Licensing Section 0233-542-0092-LF-0570 th Business Name 502 East 9 Street, Des Moines, IA 50319-0034 (515) 725-8200 www.iowadnr.gov

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: Email: 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. 06/2021 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 Officer’s Signature Date DISAPPROVED

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.

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