DNR Form 542-0160 "Change of Residency Request Form in Order to Acquire Resident Licenses and Privileges" - Iowa

What Is DNR Form 542-0160?

This is a legal form that was released by the Iowa Department of Natural Resources - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Iowa Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DNR Form 542-0160 by clicking the link below or browse more documents and templates provided by the Iowa Department of Natural Resources.

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Download DNR Form 542-0160 "Change of Residency Request Form in Order to Acquire Resident Licenses and Privileges" - Iowa

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IOWA DEPARTMENT OF NATURAL RESOURCES
Law Enforcement Bureau Residency
th
502 East 9
Street, Des Moines, IA 50319-0034
(515) 725-8200
www.iowadnr.gov
fax- (515) 725-8201
CHANGE OF RESIDENCY REQUEST FORM
IN ORDER TO ACQUIRE RESIDENT LICENSES AND PRIVILEGES
SECTION 1: CUSTOMER INFORMATION
Legal Name:
Phone #:
Address (No PO Box):
City/State/Zip:
County:
Email Address:
Birth Date:
Driver’s License or ID #:
DNR # (if known):
RESIDENCY QUALIFICATIONS
To qualify as a resident for the purposes of acquiring resident licenses and privileges issued by the Iowa Department of
Natural Resources, you must physically reside in Iowa as your primary domicile for at least 90 consecutive days
immediately before purchasing a resident privilege. Iowa must be the only place you have a true and fixed residence.
Additionally, you cannot claim residency, nor hold resident privileges in another state or country. You must have an
Iowa Driver’s license or state-issued ID in addition to 90-day residency (Go to Section 2).
OR
You may qualify for Iowa resident as a full-time student at an accredited educational institution in Iowa, if you reside in
Iowa while attending the educational institution (Go to Section 3).
SECTION 2: PLEASE ANSWER THE FOLLOWING QUESTIONS AND SUBMIT THE REQUESTED DOCUMENTATION
1. What date did you move to Iowa?
2. Are you renting or did you purchase a home?
Rent
Own
Other
3. If you own your home, have you filed for homestead tax exemption?
Yes
No
4. Did you file an Iowa resident state income tax return for the last year?
Yes
No
5. Please submit a copy of all the documents requested below.
*If you are unable to submit a document for each category below, please explain on the reverse side of this
application.
INCOME- A copy of a recent paystub that shows you have been paying Iowa income tax for 90 days or source
of income.
BILL IN YOUR NAME- A copy of one of the following: a utility bill that shows you have been at your residence
for 90 days, a cell phone bill, or other mail addressed to you at your current address that is not junk mail.
HOUSING DOCUMENTATION- A copy of one of the following: your home purchase agreement, homestead tax
exemption form, lease agreement, or a signed statement from the property owner from whom you rent or live
with that includes your name, address, and move in date.
VEHICLE REGISTRATION(S)- A copy of vehicle registration(s) for vehicles you own or drive (titles are NOT
accepted).
COPY OF YOUR DRIVER’S LICENSE- An Iowa Driver's License, or Iowa ID, is required to have this application
processed.
Please note that the processing of your application may be delayed if you do not submit all of the requested
documentation. The Iowa DNR reserves the right to request additional documentation, not listed, if there is a
question on your residency status.
(Go to Section 4 - Required)
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DNR Form 542-0160
IOWA DEPARTMENT OF NATURAL RESOURCES
Law Enforcement Bureau Residency
th
502 East 9
Street, Des Moines, IA 50319-0034
(515) 725-8200
www.iowadnr.gov
fax- (515) 725-8201
CHANGE OF RESIDENCY REQUEST FORM
IN ORDER TO ACQUIRE RESIDENT LICENSES AND PRIVILEGES
SECTION 1: CUSTOMER INFORMATION
Legal Name:
Phone #:
Address (No PO Box):
City/State/Zip:
County:
Email Address:
Birth Date:
Driver’s License or ID #:
DNR # (if known):
RESIDENCY QUALIFICATIONS
To qualify as a resident for the purposes of acquiring resident licenses and privileges issued by the Iowa Department of
Natural Resources, you must physically reside in Iowa as your primary domicile for at least 90 consecutive days
immediately before purchasing a resident privilege. Iowa must be the only place you have a true and fixed residence.
Additionally, you cannot claim residency, nor hold resident privileges in another state or country. You must have an
Iowa Driver’s license or state-issued ID in addition to 90-day residency (Go to Section 2).
OR
You may qualify for Iowa resident as a full-time student at an accredited educational institution in Iowa, if you reside in
Iowa while attending the educational institution (Go to Section 3).
SECTION 2: PLEASE ANSWER THE FOLLOWING QUESTIONS AND SUBMIT THE REQUESTED DOCUMENTATION
1. What date did you move to Iowa?
2. Are you renting or did you purchase a home?
Rent
Own
Other
3. If you own your home, have you filed for homestead tax exemption?
Yes
No
4. Did you file an Iowa resident state income tax return for the last year?
Yes
No
5. Please submit a copy of all the documents requested below.
*If you are unable to submit a document for each category below, please explain on the reverse side of this
application.
INCOME- A copy of a recent paystub that shows you have been paying Iowa income tax for 90 days or source
of income.
BILL IN YOUR NAME- A copy of one of the following: a utility bill that shows you have been at your residence
for 90 days, a cell phone bill, or other mail addressed to you at your current address that is not junk mail.
HOUSING DOCUMENTATION- A copy of one of the following: your home purchase agreement, homestead tax
exemption form, lease agreement, or a signed statement from the property owner from whom you rent or live
with that includes your name, address, and move in date.
VEHICLE REGISTRATION(S)- A copy of vehicle registration(s) for vehicles you own or drive (titles are NOT
accepted).
COPY OF YOUR DRIVER’S LICENSE- An Iowa Driver's License, or Iowa ID, is required to have this application
processed.
Please note that the processing of your application may be delayed if you do not submit all of the requested
documentation. The Iowa DNR reserves the right to request additional documentation, not listed, if there is a
question on your residency status.
(Go to Section 4 - Required)
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DNR Form 542-0160
SECTION 3: STUDENT RESIDENCE - ONLY DOCUMENTATION REQUIRED
Student Identification Card issued to you by an accredited education institution in the State of Iowa.
Current Credit Hours showing your full-time student status.
Copy of your State Driver’s License. The address on your out of state driver’s license is the address that will be
used on your customer record.
(Go to Section 4)
SECTION 4: APPLICANT ACKNOWLEDGEMENT
You MUST INITIAL next to each of the following statements as acknowledgement of your understanding:
I swear and affirm that the information I have provided on and with this form is true and accurate. I
understand I may be asked for additional information if necessary. I understand that providing false
information on this application is prohibited by Iowa Code sections 483.26 and 714.8(4) and that I may
be subject to fines, imprisonment and license revocation for the violation of these laws.
I understand that resident status changes may only be made during normal business hours. I understand
that my application will not be processed over-the-counter at a DNR office location and that a minimum of
1 week may be required for verification purposes. Upon the Department’s actions regarding residency
status, I will be contacted by the DNR via email or phone, based on the information I provided in Section 1.
To process your license request, please provide your completed application (signed, initialed and dated) and all of the
documentation as outlined above by mail, fax (515-725-8201) or email. If you choose to email your application, please
remove your social security number from any documents. Emailed applications can be sent to
webmaster@dnr.iowa.gov
Thank you.
Applicant Signature
Date
Explanations for missing documentation:
Iowa Code 483A1A(9) and Iowa Administrative Code 15.2 state: A person shall submit documentation to establish the person’s principal and primary residence or
domicile to the department or its designee upon request. The department or its designee shall keep confidential any document received pursuant to such a request if
the document is required to be kept confidential by state or federal law. The Iowa Department of Natural Resources is required to collect social security numbers from
all persons obtaining a hunting, fishing or other recreation license under section 252J.8 of the Code of Iowa and 42 US Code 666 (a)(13). Your social security number
will serve as your principal identification number to determine your eligibility for license. 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.
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DNR Form 542-0160
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