Part 1.

Personal Data

Name

First

Middle Initial

Last

Date of Birth

Month

Day

Year

Email Address

Address

Street

City

State

Zip Code

Phone

-

Area Code

Number

Representing the following company, organization or governmental body (if applicable): _________________________________________________________

Part 2.

Type of permit applied for (check one):

Class A (Commercial − Mammals and Game Birds)

Class B* (Zoos and Botanical Gardens or landowners and tenants applying for take of migratory birds on their property in accordance with a federal permit)

Class C (Governmental – Mammals and Game Birds Only)

Class D (Commercial – Migratory Birds)

Class E (Governmental – Migratory Birds)

*

Zoos and botanical garden must attach a copy of their Internal Revenue Service tax-exempt status determination letter, professional accreditation, and a map or legal description of their properties where wildlife will be controlled; landowners and tenants desiring to take migratory birds on their property must attach a copy of their Federal permit.

Part 3.

Work Area (Applicants for Class A and D Permits only)

A list of permittees is distributed to District Wildlife  Biologists and Conservation Police Officers so that they can refer complainants to permittees who service that area. Please list (in order of preference) up to four counties that you service. This list will be used strictly for referrals; your activities are not restricted to this area.

County 1

County 2

County 3

County 4

I certify that all information provided on this application is true and correct to the best of my knowledge. 

Applicant's Signature

RETURN COMPLETED APPLICATIONS TO:

Illinois Department of Natural Resources

Division of Wildlife Resources

One Natural Resources Way

Springfield IL  62702-1271