Free 37697.pdf - Indiana

REPORT OF UNSOLD LICENSES RETURNED FOR
State Form 37697 (R2/9-00) Approved by the State Board of Accounts 1990

YEAR

Department of Natural Resources Division of Fish and Wildlife

2000
Date received in Date posted in Box number

Agent account number D/B/A Street address City KIND OF LICENSES

Received of: (name of agent, county clerk, or state employee)

State NUMBER OF LICENSE NO. TO LICENSE NO. (inclusive) LICENSES LICENSES

Zip code

TOTAL

AUDIT

GRAND TOTAL
We, the undersigned, hereby certify that we have each counted the above listed licenses and verify the same to be correct. Signature of clerk, agent or state employee Date signed (month, day, year)