GAME BREEDER’S REPORT & RENEWAL APPLICATION This report is for the year ending December 31, 20 , and is required by Section 26-40 of the Connecticut General Statutes Wildlife Division, Bureau of Natural PLEASE PROVIDE YOUR INFORMATION AND SUBMIT THIS FORM AND FEE TO: Resources, Department of Energy & Environmental Protection, 79 Elm Street, Hartford, CT 06106. NAME: LICENSE NO: TEL#: EMAIL: (for renewal purposes only) STREET: TOWN: ZIP: Date: yes no I wish to renew my Game Breeder’s License sale pleasure I am engaged in breeding for the purpose of: yes no Include in Game Breeders Directory ANY PERSON MAKING A WRITTEN FALSE STATEMENT ON THIS FORM SHALL BE SUBJECT TO ARREST AS PROVIDED FOR IN SECTION 53a-157 OF THE PENAL CODE How was game acquired? (was it purchased, bred, or previously owned? Game on Hand Was it Was game Number of Game on Hand Total acquired If yes, number acquired, date acq. & reared? If yes, how game on site (List Species) Number this year? from whom (name & address.) Y/N many? from last year? Game/Eggs Sold, Given Number & Type of Game Away or Disposed of Given/Sold to: Sold, Given Away or Complete Address Date of Disposition During the Year (Name) Disposed of (List Species) UNDER NEW REGULATIONS SECTION 26-55-6 OF THE CONNECTICUT GENERAL STATUTES, IT IS NO LONGER NECESSARY TO APPLY FOR AN IMPORTATION PERMIT THROUGH THE DEPARTMENT OF ENERGY AND ENVIRONMENTAL PROTECTION FOR PIGEONS, PHEASANT, QUAIL, CHUKARS, OR MALLARDS. PLEASE CONTACT THE DEPARTMENT OF AGRICULTURE AT (860) 713-2505 OR (860) 713-2504 FOR AN IMPORTATION PERMIT OR BIRD PERMIT.
GAME BREEDER’S REPORT & RENEWAL APPLICATION This report is for the year ending December 31, 20 , and is required by Section 26-40 of the Connecticut General Statutes PLEASE PROVIDE YOUR INFORMATION AND SUBMIT THIS FORM AND FEE TO: Wildlife Division, Bureau of Natural Resources, Department of Energy & Environmental Protection, 79 Elm Street, Hartford, CT 06106. NAME: LICENSE NO: TEL#: EMAIL: (for renewal purposes only) STREET: TOWN: ZIP: Date: I wish to renew my Game Breeder’s License yes no I am engaged in breeding for the purpose of: sale pleasure Include in Game Breeders Directory yes no ANY PERSON MAKING A WRITTEN FALSE STATEMENT ON THIS FORM SHALL BE SUBJECT TO ARREST AS PROVIDED FOR IN SECTION 53a-157 OF THE PENAL CODE Game on Hand How was game acquired? (was it purchased, bred, or previously owned? Game on Hand (List Species) Total Number Was it acquired this year? If yes, number acquired, date acq. & from whom (name & address.) Was game reared? Y/N If yes, how many? Number of game on site from last year? Game/Eggs Sold, Given Away or Disposed of During the Year (List Species) Number & Type of Game Sold, Given Away or Disposed of Given/Sold to: (Name) Complete Address Date of Disposition UNDER NEW REGULATIONS SECTION 26-55-6 OF THE CONNECTICUT GENERAL STATUTES, IT IS NO LONGER NECESSARY TO APPLY FOR AN IMPORTATION PERMIT THROUGH THE DEPARTMENT OF ENERGY AND ENVIRONMENTAL PROTECTION FOR PIGEONS, PHEASANT, QUAIL, CHUKARS, OR MALLARDS. PLEASE CONTACT THE DEPARTMENT OF AGRICULTURE AT (860) 713-2505 OR (860) 713-2504 FOR AN IMPORTATION PERMIT OR BIRD PERMIT.
gamebreedersrenewreport.docx