7/31/2019 Gamebreeders' License Application

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Fee: $27.00Make Check Payable to DEEP

Wildlife Division79 Elm Street

Hartford, CT 06106

GAME BREEDERS LICENSE APPLICATION

CT General Statutes Sec. 26-40

Date: _____________________________

Application is hereby made for a permit to possess, propagate and sell game birds by:

Name of Person, Firm or Corporation Telephone Number

Mailing Address Email Address

Operations shall be conducted on the following property:

Owners Name Address of Property

I possess these birds for the purpose of: (Please circle) Sale Pleasure

If you sell gamebirds and wish to be included in the Gamebreeders Directory List, please indicate:

Yes No

I AGREE TO ADVISE THE PURCHASER OF ANY LIVE GAME BIRDS, EXCEPT THOSE SOLD FORFOOD OR IMMEDIATE LIBERATION, THAT A GAME BREEDERS LICENSE IS REQUIRED FORHIM TO LEGALLY HAVE THE BIRDS IN HIS POSSESSION AND THAT A LICENSE OR PERMIT ISOBTAINED FROM THE DEPARTMENT OF ENERGY AND ENVIRONMENTAL PROTECTION, AND I

WILL SEND TO THE DEPARTMENT OF ENERGY AND ENVIRONMENTAL PROTECTION AT THEEXPIRATION OF THE LICENSE PERIOD A TRUE REPORT OF THE NUMBER AND SPECIES OFBIRDS RAISED BY ME, THE NUMBER PURCHASED OR SOLD AND THE NAMES AND ADDRESSESOF THE PERSONS TO WHOM THEY WERE SOLD OR FROM WHOM THEY WERE PURCHASED.

(Applicants Signature)

Wildlife in my possession at the time of making this application consists of:

Species of Gamebirds Number Obtained From Address Date

(OVER)

7/31/2019 Gamebreeders' License Application

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NO FEE

APPLICATION FOR PERMIT TO IMPORT LIVE BIRDSCT General Statutes Sec. 26-55

Date:_____________________

Species, sex and number of live birds or eggs to import into the State of CT:

___________________________________________________________________________

legally taken or acquired and transported from the State of

which does not prohibit the sale or exportation of the above mentioned species, which importation or interstate

transportation is not contrary to any Federal Law or Regulation.

This stock is to be purchased from(Name of Person or Company)

(Complete Address of Breeder)

and is for the purpose of:

hunting event

food

breeding in captivity other

If animals are to be liberated, give town location:

It is understood that a separate application must be made for each shipment of live birds/eggs, reptiles,

amphibians, mammals or invertebrates and that permits may be issued or denied at the discretion of the

Commissioner.

Signature and Title of Applicant

Make checks payable to: Department of Energy and Environmental Protection (DEEP)

Send completed application along with payment to:Department of Energy and Environmental ProtectionWildlife Division 6th Floor79 Elm StreetHartford, CT 06106

Rev. 7/12/2011