"Application for Game Bird Hunting Preserve Permit (Code 550)" - Missouri

Application for Game Bird Hunting Preserve Permit (Code 550) is a legal document that was released by the Missouri Department of Conservation - a government authority operating within Missouri.

Form Details:

  • Released on April 1, 2020;
  • The latest edition currently provided by the Missouri Department of Conservation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Missouri Department of Conservation.

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Download "Application for Game Bird Hunting Preserve Permit (Code 550)" - Missouri

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OFFICE USE ONLY
MISSOURI DEPARTMENT OF CONSERVATION
PHONE: (573) 522-0107
P.O. BOX 180
FAX: (573) 751-4864
JEFFERSON CITY, MO 65102
EMAIL: COMMERCIALPERMITS@MDC.MO.GOV
Application for
Game Bird Hunting Preserve
Permit (
)
CODE 550
All required (*) fields must be completed or application will be returned to applicant for completion.
*SECTION 1: Are you applying as an individual or business? Selection will determine the name on permit.
INDIVIDUAL (If Individual, skip Section 4)
BUSINESS (If Business, skip Section 3)
SECTION 2: If renewing a commercial permit, enter the permit number here.
Permit #:
SECTION 3: Individual Information (Permit will be issued in the individual’s name.)
*County:
*Individual Name:
Doing Business As (
):
If applicable – provide fictitious business name registered with MO Secretary of State
*Address:
*City:
*State:
*ZIP Code:
If PO BOX, provide physical address:
*Telephone:
Email:
SECTION 4: Business Information
(Permit will be issued to the business. All business applicants must be registered
and in good standing with the Missouri Secretary of State. For more information go to: www.sos.mo.gov or call (573) 751-
4936)
*SELECT TYPE OF ENTITY:
GENERAL PARTNERSHIP
LIMITED PARTNERSHIP
LIMITED LIABILITY PARTNERSHIP
☒ NONPROFIT CORPRATION
GENERAL CORPORATION
LIMITED LIABILITY COMPANY
NONPROFIT CORPORATION
*County:
*Business Name:
Doing Business As (
):
If applicable – provide fictitious business name registered with MO Secretary of State
*Business Address:
*City:
*State:
*ZIP Code:
If PO BOX, provide physical address:
Telephone:
Email:
*Designated Representative’s Name (for all Department interaction)
1
:
*Designated Representative’s Address (if different than above):
*City:
*State:
*ZIP Code:
*Telephone:
Email:
1
Designated representative is an individual designated by the business as the contact person for all purposes related to the permit including regulatory
compliance, records, inspections and citations. The business (permittee) is responsible for updating this information if the designated representative changes at
any time.
*HUNTING PRESERVE SPECIES – Species to be handled during permit period
Pheasant
Quail
Mallard Duck
Exotic Partridge
*HUNTING PRESERVE LOCATION
Location (County):
Section:
Township:
Range:
Location Address (if applicable):
Area Acreage:
Conservation Agent Use Only
Signature constitutes acceptance of all rules pertaining to the above permit(s) according to the Wildlife Code of Missouri.
☐ Approved
☐ Disapproved
Applicant Signature: __________________________________________________
Date: _______________
Signature: ________________
Applicant’s Title (if applicable – required for business applications): _____________________________________
Date: ____________________
All permits expire June 30 unless otherwise provided in the Wildlife Code of Missouri.
This is not a permit and does not entitle the applicant to operate.
4/2020
Page 1 of 2
OFFICE USE ONLY
MISSOURI DEPARTMENT OF CONSERVATION
PHONE: (573) 522-0107
P.O. BOX 180
FAX: (573) 751-4864
JEFFERSON CITY, MO 65102
EMAIL: COMMERCIALPERMITS@MDC.MO.GOV
Application for
Game Bird Hunting Preserve
Permit (
)
CODE 550
All required (*) fields must be completed or application will be returned to applicant for completion.
*SECTION 1: Are you applying as an individual or business? Selection will determine the name on permit.
INDIVIDUAL (If Individual, skip Section 4)
BUSINESS (If Business, skip Section 3)
SECTION 2: If renewing a commercial permit, enter the permit number here.
Permit #:
SECTION 3: Individual Information (Permit will be issued in the individual’s name.)
*County:
*Individual Name:
Doing Business As (
):
If applicable – provide fictitious business name registered with MO Secretary of State
*Address:
*City:
*State:
*ZIP Code:
If PO BOX, provide physical address:
*Telephone:
Email:
SECTION 4: Business Information
(Permit will be issued to the business. All business applicants must be registered
and in good standing with the Missouri Secretary of State. For more information go to: www.sos.mo.gov or call (573) 751-
4936)
*SELECT TYPE OF ENTITY:
GENERAL PARTNERSHIP
LIMITED PARTNERSHIP
LIMITED LIABILITY PARTNERSHIP
☒ NONPROFIT CORPRATION
GENERAL CORPORATION
LIMITED LIABILITY COMPANY
NONPROFIT CORPORATION
*County:
*Business Name:
Doing Business As (
):
If applicable – provide fictitious business name registered with MO Secretary of State
*Business Address:
*City:
*State:
*ZIP Code:
If PO BOX, provide physical address:
Telephone:
Email:
*Designated Representative’s Name (for all Department interaction)
1
:
*Designated Representative’s Address (if different than above):
*City:
*State:
*ZIP Code:
*Telephone:
Email:
1
Designated representative is an individual designated by the business as the contact person for all purposes related to the permit including regulatory
compliance, records, inspections and citations. The business (permittee) is responsible for updating this information if the designated representative changes at
any time.
*HUNTING PRESERVE SPECIES – Species to be handled during permit period
Pheasant
Quail
Mallard Duck
Exotic Partridge
*HUNTING PRESERVE LOCATION
Location (County):
Section:
Township:
Range:
Location Address (if applicable):
Area Acreage:
Conservation Agent Use Only
Signature constitutes acceptance of all rules pertaining to the above permit(s) according to the Wildlife Code of Missouri.
☐ Approved
☐ Disapproved
Applicant Signature: __________________________________________________
Date: _______________
Signature: ________________
Applicant’s Title (if applicable – required for business applications): _____________________________________
Date: ____________________
All permits expire June 30 unless otherwise provided in the Wildlife Code of Missouri.
This is not a permit and does not entitle the applicant to operate.
4/2020
Page 1 of 2
PERMIT TYPE
PRICE
☐ Game Bird Hunting Preserve Permit (Code 550)
$100.00
TAG TYPE
PRICE
# REQUESTED
TAG TOTAL
Transportation Stickers (per 100)
$10.00
X
_______________
=
_______________
*3-day and Annual Licensed Hunting Preserve Permits are available through an online sales
channel provided to hunting preserves.
Total Amount Due: $
________________
Check enclosed (Made payable to: Missouri Department of Conservation)
Credit/Debit card holder agrees to perform the obligations set forth in the Cardholder’s agreement with the Issuer.
As required by State Law, payments by debit or credit card will be charged an extra convenience fee according to the chart
below. The fee will be added to the amount of the purchase and the cardholder’s statement will show the combined amount.
This fee is paid to the payment processor, not the Missouri Department of Conservation.
Transaction Amount
Fee Amount
$0-$50.00
$1.25
$50.01-$75.00
$1.75
$75.01
$2.15
$100.01 and up
2.15%
Credit Card Type:
Visa
MasterCard
Discover
Credit/Debit Card Number: _____________________________________________________________________________
Expiration Date: ____________________________
3-Digit Security Code: ____________________
Phone Number (Required): ___________________
Signature: _____________________________________
Mail application to:
Missouri Department of Conservation
Attn: Commercial Permits
P.O. Box 180
Jefferson City, MO 65102
Fax: (573) 751-4864
Email: COMMERCIALPERMITS@MDC.MO.GOV
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