Utah Division of

Wildlife ResourcesApplication for Certificate of Registration

Possesson of Fallow Deer, Caribou or Muskox (R657-3)

A $10 non-refundable handling fee is required. Do not mail cash. You may enclose a check or money order payable to DWR, pay in person at a Division Office or arrange to make a credit card payment over the phone. Please list your phone number here to arrange payment by phone. If your application is approved, additional fees may be billed.

Before applying, please read carefully: This document allows you to apply for a Certificate of Registration (COR) that allows for the possession, importation, purchase, propagation, sale, barter, trade or disposal of Fallow Deer, Caribou or Muskox. For details of animal species and activities permitted by this COR, please visit: http://goo.gl/Zyl4ZKIn many instances, other agency (federal/state/county/city/municipal) laws covering live possession of animals or groups of animals, pond/facility locations, water rights, etc may be in effect. If local laws (city/county) restrict live possession of any zoological animal, written permission from the local entity granting authority to possess such animal must be submitted with this application. The applicant is responsible for complying with such laws prior to submitting a COR application.

If a federal permit is required for the activity applied for herein (US Fish & Wildlife, US Department of Agriculture, etc), submit with this application either a copy of the permit or a copy of the application for the federal permit.Questions about this application or the COR program? Please call 801-538-4701 or email tdsmart@utah.govCOR Use Type

Commercial ($150 COR FEE): means any activity through which a person in possession of an animal:(a) receivesany consideration for that animal or for a use of that animal, including nuisance control and roadkill removal; or (b) expects to recover all or any part of the cost of keeping the animal through selling, bartering, trading, exchanging, breeding, or other use, including displaying the animal for entertainment, advertisement, or business promotion.Educational ($75 COR FEE):means the possession and use of an animal for conducting educational activitiesconcerning wildlife.Personal ($75 COR FEE): means the possession and use of an animal for a hobby or for its intrinsic pleasure andwhere no consideration for the possession or use of the animal is received by selling, bartering, trading, exchanging, breeding, hunting or any other use.Scientific ($75 COR FEE): means the possession and use of an animal for conducting scientific research that isdirectly or indirectly beneficial to wildlife or the general public.

ZIPStateEmail

NameApplicant Information

AddressOrganization City Phone

Purpose Please provide a description of the proposed activities - attach additional sheets if needed. A project proposal oroutline must accompany this application if applicable.

AddressState

City

GPS(provide a coordinate as close to the middle of the area as possible)ZIP County

Location Information (specific locaitons where game animals will be held; if multiple locations will be used include anattachment detailing those locations)

ZIPName Address

PhoneCity State

COR Number

Supplier Information (the person from whom you are purchasing/trading/bartering animals instate must have avalid certificate of registration to do so)

Requested Dates Start Date End Date

This application packet filled out completely and signed below A $10 non-refundable handling feeCopies of federal permits or applications (if applicable)

Is your application complete? Incomplete applications may result in delays in approval and issuing of a COR. A complete application consists of:

Mail completed applications to:Utah Division of WildlifeATTN: COR OfficeBox 146301Salt Lake City, Utah 84114-6301

Or if sending via FedEx or UPS: Utah Division of Wildlife ATTN: COR Office1594 West North Temple,Suite 2110Salt Lake City, Utah 84116

I hearby certify that I have read and am familiar with the rules pertaining to the activity(ies) applied for and that I accept any and all liability resulting from the issuance of a certificate of registration. I futher certify the information submitted in this application for a COR is complete and accurate to the best of my knowledge and belief. I understand that any false statement herein may result in the application being denied. Please note that accepting payment from you neither implies issuance or denial of a certificate of registration.

Applicant Signature DateParent or Guardian Signature (if applicant is a minor)

Application for Certificate of Registration - page 2

Possesson of Fallow Deer, Caribou or Muskox (R657-3) Revised March 2016

Species Information List all species, genders and numbers used in the activity. Use additional sheets if needed.

Species Sex Number Final Disposistion (e.g. retain, release, euthanize, etc)