Iowa Department of Natural Resources



|[pic] | |IOWA DEPARTMENT OF NATURAL RESOURCES |

| | |Licensing Section |

| | |502 E 9th St, Des Moines, IA 50319-0034 |

| | |(515) 725-8200 |

REGISTRATION FOR RESIDENT LANDOWNER/TENANT DEER & TURKEY LICENSES

Provide ALL of the following information:

Please print clearly (If we cannot read your writing we will return this form unprocessed.)

|Applicant Information |

|Last Name: |      |First Name: |      |

|Mailing Address: |      |

|City: |      |State: |      |Zip: |      |

|Phone #: |     |Email: |      |

|Date of Birth: |     |Gender: | Male Female |

|Height: |      |Weight: |      |Eye Color: |      | |

| |

|Provide at least TWO (2) of the three number listed below: |

|Iowa DNR # |      |Social Security #*: |     |Driver’s License # and State:|      |

|(if known): | | | | | |

|*The Iowa Department of Natural Resources is required to collect social security numbers from all persons obtaining a hunting, fishing or other recreational |

|license under section 252J.8 of the Code of Iowa and 42 US Code 666(a)(13). You social security number will serve as your principal identification number to |

|determine your eligibility for licenses. It will be provided to law enforcement agencies and the Iowa Child Support Collection Unity to establish, modify, and |

|enforce child support obligations and to collect liabilities owed to the state or a state agency. It WILL NOT appear on your license. |

| |

|*SSN required if your do not know your DNR Number or have never purchased an Iowa hunting/fishing license. |

|I am registering as a (Check ONLY ONE, either I or II): |

|I |Landowner, |II |Tenant, |

| |Spouse of Landowner, or | |Spouse of Tenant, or |

| |Child of Landowner | |Child of Tenant |

|(If selected, complete Sections A and C only) |(If selected, complete Sections B and C only) |

|Section A |

|I attest that I am eligible for free and reduced-fee deer and wild turkey hunting licenses because I meet one of the following criteria: (If registering as a |

|landowner or family member of a landowner, you MUST CHECK ONLY ONE box for 1, 2, or 3.) |

|1 |LANDOWNER: I am a resident of Iowa and I own at least 2 contiguous acres of qualifying agricultural land. I do not use a third party, such as a farm |

| |management company, to make annual farm operating decisions. |

| |(If you checked Box 1, you MUST CHECK AT LEAST ONE box for a-e below.) |

| | I am the farm operator on that farmland, or |

| |I make annual decisions about the farm operations that are carried out by renters, laborers, or custom applicators, or |

| |I raise specialty crops (orchards, nurseries, trees, etc.), listed below, on that land, or |

| | |      | |

| | All or part of my land is enrolled in the conservation reserve program, or |

| |I rent my farm to my adult child who operates the farm. |

|2 |LANDOWNER SPOUSE: I am the spouse of a landowner who qualifies for free licenses as described in Statement 1, I reside with that landowner, and the |

| |county number and parcel identification number listed in Section C are for qualifying land owned by that landowner. |

|3 |LANDOWNER CHILD: I am the child of a landowner who qualifies for free licenses as described in Statement 1, I reside with that landowner, and the county |

| |number and parcel identification number listed in Section C are for qualifying land owned by that landowner (If you checked Box 3, you MUST CHECK ONLY |

| |ONE box for f or g below.) |

| | I am under 18 years old, or |

| |I am 18 or 19 years old and I am enrolled in high school or a GED program. |

|GO TO SECTION C |

|Section B |

|I attest that I am eligible for free and reduced-fee deer and wild turkey hunting licenses because I meet one of the following criteria: (If registering as a |

|tenant or family member of a tenant, you MUST CHECK ONLY ONE box for 4, 5, or 6.) |

|4 |TENANT: I am a resident of Iowa and I rent and actively farm agricultural land owned by another person. |

|5 |TENANT SPOUSE: I am the spouse of a tenant who qualifies for free licenses as described in Statement 4, I reside with that tenant, and the county number |

| |and parcel identification number listed in Section C are for qualifying land rented by that tenant. |

|6 |TENANT CHILD: I am the child of a tenant who qualifies for free licenses as described in Statement 4, I reside with that tenant, and the county number |

| |and parcel identification number listed in Section C are for qualifying land rented by that tenant. (If you checked Box 6, you MUST CHECK ONLY ONE box |

| |for h or i below.) |

| | I am under 18 years old, or |

| |I am 18 or 19 years old and I am enrolled in high school or a GED program. |

|7 |Provide the NAME, ADDRESS, and TELEPHONE NUMBER of the landowner who owns the parcel of agricultural land that you rent. The person listed below must be |

| |the owner of the parcel of land that you list for number 8 in Section C below. |

|Landowner Last Name: |      |Landowner First Name: |      |

|Landowner Mailing Address: |      |

|Landowner City: |      |Landowner State: |      |Landowner Zip: |      |

|Landowner Phone #: |      | |

|GO TO SECTION C |

|Section C |

|8 |Provide the COUNTY NUMBER and PARCEL IDENTIFICATION NUMBER for ONE parcel of agricultural land that qualifies you for a Landowner/Tenant License. See |

| |“INSTRUCTIONS” for locating the parcel number. Tenants must get this number from the landowner who rents qualifying land to them. The DISTRICT NUMBER** is |

| |also required for Keokuk County. |

| |IMPORTANT: A landowner and all of his/her qualifying family members must register using the same County # and the same Parcel Identification Number. |

| |Likewise, a tenant and all of his/her qualifying family members must register using the same County # and Parcel Identification Number. The same District |

| |Number must also be used, when applicable.* |

|County # | |District #** | |Parcel Identification Number |

|  |

|9 |Provide the full legal name of the landowner, as it appears on the deed, who owns the parcel of land listed in number 8 above. If the property is named |

| |under a trust, business, corporation, LLC, etc; that name must be provided for verification purposes. You may use both the First Name and Last Name text |

| |boxes if necessary. Also, if land is owned by more than one individual or a corporation, you must also include a list of all individual owners and their |

| |home address. |

|Landowner Last Name: |      |Landowner First Name: |      |

|10 |By signing this affidavit, I attest that all of the information provided is true. I understand that I may be subject to conviction of a misdemeanor and |

| |loss of hunting privileges if the information I have provided is proven to be false under Iowa Code 714.8(4). |

| | | |

|Signature | |Date |

WARNING: Incomplete or illegible application will delay the registration process.

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