Oregon Department of Fish and Wildlife FOR OFFICIAL USE ONLY Wildlife Division – Wildlife Permits 4034 Fairview Industrial Drive SE Date: Salem OR 97302 Phone: (503) 947-6315 Approved By: Fax: (503) 947-6117 Game Bird Propagation License Application A Propagation License is required to raise game birds or their eggs for sale. A Propagation License is not required to purchase and hold propagated game birds for personal use. Application must include copy of federal permit for all migratory game birds protected by the Migratory Bird Treaty Act. Name of Permit Holder Calendar Year: Mailing Address FIRST-TIME APPLICATION RENEWAL City State Zip Facility address where animals are held Previous year’s permit number Street Address Federal permit number City State Zip Social Security Number Non-refundable *(required by federal and state law; see bottom of page) License Fee - $58.00 Includes $2.00 agent fee per ORS 497.022. Phone DOB PAYMENT METHODS: See page 3 E-mail License expires December 31 Have you ever been convicted of, admit to, a wildlife law, rule, or permit violation in the past 5 years? Yes No If yes, explain: I request a Game Bird Propagation License for the following species that I plan to sell. List of approved species on page 3. This section must be completely filled out. Species Number of Birds on Number of Eggs on Include scientific name and common name Hand Hand *Per federal and state law (ORS 25.785), the Department requests that you provide your social security number. The record of your social security number may be used for child support enforcement and tax administration purposes (including identification) only, unless you authorize other uses of the number. ________ (initial here) If I am applying to propagate federally-protected migratory game birds (ducks, geese, etc) then I have included a copy of my federal permit with this application. ________ (initial here) I have read and understand the Oregon Administrative Rules that govern the Game Bird Propagation License on page 3. Applicant Signature Date For those wishing to pay for a Game Bird Propagation License application; please complete the section below and fax this form to 503-947-6117 or mail to address below. DO NOT EMAIL THIS FORM. PAYMENT METHOD: Check/Money Order to ODFW enclosed Credit Card Info provided below Credit Card Payment Authorization Name of Credit Card Holder: ___________________________________ Contact Telephone: ___________________________________________ □ VISA MasterCard Discover Credit Card #: Exp. Date: CVC#: By signing below, I authorize the Oregon Department of Fish and Wildlife to bill my credit card in the amount of $58.00 for the Game Bird Propagation License Application. Signature Date RETURN THIS FORM AND APPLICATION TO: Fax: 503-947-6117 Mail: ODFW Licensing 4034 Fairview Industrial Dr SE Salem, OR 97302 OAR 635, Division 044 Game Bird Propagation License Requirement Any person or business desiring to propagate for sale any game bird, limited to the following bird species in the families listed below, must submit a complete application and a non-refundable application fee of $58 and license agent fee listed on the permit application: (a) Columbidae (mourning doves and band-tailed pigeons only); (b) Anatidae (all species except mute swans and Egyptian geese); (c) Phasianidae (A) Subfamily Phasianinae species only; (B) Subfamily Tetraoninae (grouse and ptarmigan except Genuses Centrocercus and Tympanuchus); (C) Subfamily Meleagridinae (wild turkey); and (D) Subfamily Perdicinae (partridges and common quail (Coturnix coturnix); (d) Odontophoridae (Genuses Callipepla, Colinus, and Oreortyx only); and (e) Scolopacidae (Gallinago delicate only). Permit is NOT needed for Coturnix japonica (Japanese quail). Game Bird Propagation Licenses expire on December 31 of the year issued. Shipping Requirements: Any game birds shipped within or outside the state by the holder of a Game Bird Propagation License must have affixed to the shipping container a record showing: (a) Name, address, and Game Bird Propagation License number of shipper; (b) Name and address of consignee; (c) Species name (common and scientific) and numbers of game birds contained; and, (d) Import of game birds into the state of Oregon requires a Certificate of Veterinary Inspection from a federally accredited veterinarian and must be accompanied by an Oregon Department of Agriculture import permit with exceptions listed in OAR 603-011-0255. Record Keeping and Reporting Requirements: A record of all business transactions involving sale or purchase of eggs or game birds, must be current to date and available at the facility as listed on the permit. Records for the current calendar year must be made available for inspection by Oregon State Police or Oregon Department of Fish and Wildlife personnel. An annual report of operations must be received with the annual renewal application and fees before the date of permit expiration. The annual report shall include the total number of game birds by species purchased or acquired and all sales or transfers by species, including eggs, births and deaths within the previous calendar year. Imported or exported game birds must have a certificate of veterinary inspection and any import permit or license and documentation of ownership or other information that may be required by the receiving state. Cancellation and Non-Renewal of License Failure to comply with any requirements within these rules or conditions of authorization is cause to cancel or deny renewal of the Game Bird Propagation License and confiscate or require disposal of the wildlife being held. A person may appeal cancellation or denial of a license or permit through a contested case hearing. The request for a contested case hearing on a proposed cancellation must be received by the Department within 21 days after service of notice (or 90 days for emergency revocations). The request for hearing on a proposed non-renewal must be received by the Department within 60 days of notice. Final Orders in contested case hearings will be issued by the Director. .