Form 9400 019 PDF Details

The process of applying for a Guide License in the State of Wisconsin is outlined by the Department of Natural Resources through Form 9400-019. This essential document serves as the first step for individuals aspiring to legally guide, direct, or assist others in hunting, trapping, or fishing within the state's boundaries. Applicants are required to provide comprehensive information including personal identification details, a statement of oath, and a statutory fee of $40.00, all of which are prerequisites for the consideration of their application. The form mandates disclosure of a social security number or federal employer identification number, pursuant to Chapter 29 of the Wisconsin Statutes, ensuring the application's authenticity and adherence to legal standards. Additionally, it highlights the Department's authority to use the collected information for various purposes including law enforcement, eligibility assessments, and participation in surveys, while also stipulating the conditions under which this information may be shared under Wisconsin's open records law. The submission of Form 9400-019 not only signifies the applicant's commitment to respecting and upholding the state’s fish and wildlife laws but also acts as a covenant to perform the duties of a licensed guide with integrity and faithfulness.

QuestionAnswer
Form NameForm 9400 019
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesWorkforce, surveys, pursuant, approvals

Form Preview Example

Mail to:

Resident Guide License Application

Department of Natural Resources

Form 9400-019

(R 6/09)

Guide Application - CS/1

 

 

PO Box 7924

Madison, WI 53707-7924

LICENSE FEE $40.00

NOTICE: This form is required by the Department for any application filed pursuant to s. 29.512, Wis. Stats.The Department will not consider your application unless you complete and submit this application. Information collected may be used for participation in surveys, eligibility for approvals, law enforcement (including child support and tax delinquency enforcement) purposes and other secondary purposes. The Department may also provide this information to requesters pursuant to Wisconsin's open records law, ss. 19.31-19.39, Wis. Stats.

TO BE USED BY ISSUING AGENT

License Number

Date Issued

Issued By

*A social security number or federal employer identification number is REQUIRED when applying for a license according to Chapter 29, Wis. Stats., but it may not be disclosed to anyone except the Department of Workforce Development or the Department of Revenue.

Pursuant to the provisions of section 29.512(1), Wis. Stats., I hereby apply for a Guide License to guide, direct, or assist other persons in hunting, trapping or fishing in the State of Wisconsin. I also submit below my oath of office as provided by law and the statutory fee of $40.00 for the Guide License.

(please print or type)

Last Name

 

 

First

 

 

 

 

 

 

 

MI

 

DNR Customer Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street or Route

 

 

 

 

 

City

 

 

 

 

 

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Social Security Number/Federal Employer ID No.

 

 

 

Wisconsin Driver's License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County of Residence

 

 

 

 

 

Daytime Telephone Number (include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (mm-dd-yyyy)

Color Eyes

 

Color Hair

 

 

 

Weight

Height

Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Withhold personal identifiers collected on this form from

Make checks payable to: Department of Natural

 

 

 

 

 

 

Resources OR please charge my:

 

 

 

 

 

 

 

 

 

 

 

 

disclosure on any list of 10 or more individuals that the DNR is

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

requested to provide to another person [s. 23.45, Wis. Stats.].

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Visa

 

 

 

Mastercard Date Expires

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are your license privileges now revoked by reason of a conviction

 

Card No. __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

for violation of the fish or wildlife laws?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(THE LICENSE ISSUED ON THIS APPLICATION WILL EXPIRE ON DECEMBER 31)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I solemnly swear that I will well and faithfully perform the duties of the office of a Guide licensed by the State of Wisconsin Department of Natural Resources to guide, direct and assist other persons in hunting, trapping, and fishing, all in accordance with the provisions of s. 29.512(1), Wis. Stats.

I solemnly swear that I am the person making the above application; that the statements therein are true; that my license privileges are not now revoked by reason of a conviction for a violation of the fish or wildlife laws; that I will not permit any other person to use my license; that I am a resident of Wisconsin and at least eighteen years of age; and that I will faithfully observe and comply with the fish and wildlife laws and Wisconsin Administrative Code of the State of Wisconsin.

Signature of Applicant

Date Signed

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Wisconsin conclusion process detailed (step 1)

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