Form Pr1350 – Fill Out and Use This PDF

LINE BY LINE INSTRUCTIONS FOR COMPLETING THIS APPLICATION

1.Applicant’s Address: Print or type your name and address. When your approved permit is returned, this information will appear through a windowed envelope. Be sure the information is legible and includes your ZIP code.

2.Applicant Information: “Number of acres under fence” may be left blank if less than one. “Telephone number to appear on the commercial breeder’s list” should be left blank if the permit is required for noncommercial purposes as indicated in item 6.

3.Location Where Animals Are Held: Leave blank, unless your animals are held (renewal applicants), or will be held (new applicants) at a location other than that stated in item 1. This does NOT allow the animals to be held at both locations. A separate permit is required for each location animals are held.

4.Species and Number of Animals:

New — List each species you plan on acquiring. Enter the number of animals you actually possess as of the date of this application. For new applicants this number should be zero. Your initial acquisition of animals and any subsequent additions or subtractions from your inventory must be reported on a Monthly Inventory Report (PR1350-2) as explained within the Information Circular for Permits to Hold Wildlife in Captivity (IC1350-1). You will receive one Monthly Inventory Report with your permit. This form should be used for reporting your initial acquisition of animals. You will also receive a Supply Order Form for ordering additional Monthly Inventory Reports and Official Shipping Tags. If animals have been acquired before obtaining a permit, a letter of explanation must be attached to this application. (See the IC1350-1.)

Renewal — List the species and number of animals you possess as of the date of this application. (See IC1350-1.)

Amended — List all species you currently possess, plus those you plan on acquiring. Do NOT list only the new species. Enter zero under “number” for species you plan on acquiring. When the amended permit is approved, it will become your new permit. Report your new speices on a Monthly Inventory Report (PR1350-2) after you receive your approved amended permit. (See IC1350-1.)

5.Type of Permit:

New — You must obtain holding facilities that meet or exceed the minimum enclosure specifications and amenities for each species you plan on acquiring BEFORE this application is submitted. (See IC1350-1.) You must obtain your approved permit BEFORE you acquire your animals. (See IC1350-1.)

Renewal — Do not forget to indicate your permit number. (See IC1350-1.)

Amended — If ANY information on your approved permit needs to be changed, you must submit an amended application. If you plan to add species to your inventory that are not listed on your permit, adequate enclosures must be obtained for the species you plan on acquiring BEFORE an amended application is submitted. An approved amended permit must be obtained BEFORE the new species are acquired. For species that are currently listed on your permit, additional animals may be acquired without amending your permit provided:

1) you submit a Monthly Inventory Report (PR 1350-2) indicating the number of additional animals, and 2) your total number of animals does not exceed the minimum space requirements for that species. (See IC1350-1.)

6.Permit Required For: This question is asked for information purposes only. All permittees are bound by the same regulations, regardless of whether they hold the permit for commercial or noncommercial purposes. (See IC1350-1.)

7.Zoned: Unless zoned agricultural, the Department shall request approval from the city, township, or village where the premises is located. A copy of the application will be provided to them. Written approval must be obtained within 30 days from the date requested.

8.Applicant/Permittee Signature: Sign and date the application. Your signature certifies that you have read and understand the front and back of this application and IC1350-1 and you will abide by all requirements of this permit. (See IC1350-1.) Furthermore, permittee agrees to the following:

LIABILITY. Grantee hereby releases, waives, discharges and covenants not to sue the State of Michigan, its departments, officers, employees and agents, from any and all liability to Grantee, its officers, employees and agents, for all losses, injury, death or damage, and any claims or demands thereto, on account of injury to person or property, or resulting in death of Grantee, its officers, employees or agents, in reference to the activities authorized by this permit.

INDEMNIFICATION. Grantee hereby covenants and agrees to indemnify and save harmless, the State of Michigan, its departments, officers, employees and agents, from any and all claims and demands, for all loss, injury, death or damage, that any person or entity may have or make, in any manner, arising out of any occurrence related to (1) issuance of this permit; (2) the activities authorized by this permit; and (3) the use or occupancy of the premises which are the subject of this permit by the Grantee, its employees, contractors, or its authorized representatives.

9.Fee and Mailing Instructions:

New or Renewal Applications — STAPLE a check or money order (payable to State of Michigan) to the completed application. Send to: CASHIER’S OFFICE, MICHIGAN DEPARTMENT OF NATURAL RESOURCES, PO BOX 30451, LANSING MI 48909-7951. Normally, the permit fee is $45.00. However, if you have more than 500 animals or more than 40 acres enclosed, the fee will be determined as described on page 5 of IC1350-1.

Amended Applications — There is no fee for amended applications. Mail amended applications as instructed on the front of this form.

You should receive your approved permit within 45 days of the date sent. Your permit will be valid from the date of issue to the third June 30 after issue. For example, a permit issued March 1, 2008 would be valid until June 30, 2010

QUESTIONS? Contact Permit Specialist: DNR, WILDLIFE DIVISION, PO BOX 30444, LANSING, MI 48909-7944, (517) 284-6210.