Free 47056.pdf - Indiana

APPLICATION FOR FISH STOCKING PERMIT
State Form 47056 (R / 12-07) Approved by State Board of Accounts, 2007

FEE: $3.00
Instructions:

1. Please print or type information. 2. Be sure to read all regulations. 3. Attach check or money order made payable to Division of Fish and Wildlife and return to: Division of Fish and Wildlife Commercial License Clerk 402 W. Washington Street, Room W273 Indianapolis, IN 46204

DEPARTMENT OF NATURAL RESOURCES Attn: Commercial License Clerk Division of Fish and Wildlife 402 W. Washington St., Rm W273 Indianapolis, IN 46204-2781 Phone: (317) 232-4094 Fax: (317) 232-8150

A permit is needed to stock fish in the waters containing state-owned fish, waters of this state, or boundary waters of this state under rules adopted by the department (IC 14-22-9-8). Name of Applicant (First, Last) Name of Company or Organization Address (Number and Street, City, State, and ZIP Code)

Telephone Number (

)

E-Mail Address

Name and Title of Principal Officer (if applicable) LOCATION WHERE FISH WILL BE STOCKED County Nearest Town Type of Fish to be Stocked Name of Lake or Stream Proposed Stocking Date

Number of Fish to be Stocked Source of Fish

Size of Fish to be Stocked

FOR OFFICE USE ONLY Permit Number Date sent to District Biologist Approved Denied Approved by Date Date Issued Check Number