Free 03070.pdf - Indiana

APPLICATION FOR FUR BUYER'S LICENSE
State Form 3070 (R8 / 11-08) Approved by State Board of Accounts, 2008

DEPARTMENT OF NATURAL RESOURCES

Instructions:

1. Please type or print information. 2. Be sure to read all regulations. 3. All sections must be complete before submitting.

Attn: Permit Coordinator Division of Fish and Wildlife 402 W. Washington St., Rm. W273 Indianapolis, IN 46204-2781 Telephone: (317) 232-4102 Fax Number: (317) 232-8150

Check One: Check one: Today's Date

New Applicant

Renewal

License Year: July 1, 20

through June 30, 20

Resident Fur Buyer (FEE: $75.00)

Non-Resident Fur Buyer (FEE: $125.00)

Name of Applicant (individual) Name of Business (if applicable) Address (Number and Street or Rural Route) City County E-Mail Address State Telephone Number (

Date of Birth

ZIP Code )

Business Information: Business Address (if different from above): City County Location of Principal Office (if different from above): Locations of Branch Offices: State Telephone Number ( ZIP Code )

Please return completed application with the license fee to the address shown above. AGREEMENT I hereby apply for a license to engage in the business of buying fur bearing mammals or their hides, skins, furs or carcasses directly from a trapper or from other licensed buyers in the State of Indiana. I have read and understand the regulations and agree to abide by them. Under penalties of perjury (IC 35-44-2-1), I certify that the information supplied by me is true and correct to the best of my knowledge. Signature of Applicant: Date:

FOR OFFICE USE ONLY Date Application Received License Number Approved by Check/Money Order Number Date License Issued Date Approved License Year