Free 45231.pdf - Indiana

APPLICATION FOR DOG TRAINING GROUND PERMIT
State Form 45231 (R3/9-07)

Department of Natural Resources
DEPARTMENT OF NATURAL RESOURCES Division of Fish and Wildlife 402 W. Washington Street, Room W273 Indianapolis, IN 46204-2781 Telephone: (317) 233-6527 Fax Number: (317) 232-8150

Instructions:

1. Please type or print information. 2. Be sure to read all regulations. 3. All sections must be complete before submitting. 4. Mail completed application to address shown at right.

Please check one of the following: New Applicant (A copy of the deed or lease must be attached to verify ownership.) Renewal Name of Applicant Last Name Name of Club/Organization (if applicable) Address (Number and Street or Rural Route) City County State Telephone Number ( ZIP Code ) First Name Mid. Initial Date

Address of Dog Training Ground if not the same as residence:

City County I certify that I am the Owner or Lessee of I will use County Range Section

State Telephone Number ( acres of land.

ZIP Code )

acres for a Dog Training Ground legally described as follows: Township Quarter Section

I have read and understand the regulations and agree to abide by them. Under the penalties of perjury (IC 35-44-2-1), I affirm that the information supplied by me is true and correct to the best of my knowledge. Signature of Applicant FOR OFFICE USE ONLY Issue Date: Approved by: Comments: Exp. Date: Date: Date