First Name:   *
M.I.    
Last Name:   *  
IDNR Customer Number:   *
Business Name:     
Street Address / P.O. Box No. / RFD No. :   *  
City:   *
 State:   *
 Zip code:   *
Home Phone/Cell Phone:   *
Business Phone:    Ext:  
E-Mail:   * *  
Legal Description of Training Area (Example: SE 1/4, NW 1/4, Sec 10., R14N T8W):   *  
County:   ADAMS ALEXANDER BOND BOONE BROWN BUREAU CALHOUN CARROLL CASS CHAMPAIGN CHRISTIAN CLARK CLAY CLINTON COLES COOK CRAWFORD CUMBERLAND DEKALB DEWITT DOUGLAS DUPAGE EDGAR EDWARDS EFFINGHAM FAYETTE FORD FRANKLIN FULTON GALLATIN GREENE GRUNDY HAMILTON HANCOCK HARDIN HENDERSON HENRY IROQUOIS JACKSON JASPER JEFFERSON JERSEY JODAVIESS JOHNSON KANE KANKAKEE KENDALL KNOX LAKE LASALLE LAWRENCE LEE LIVINGSTON LOGAN MACON MACOUPIN MADISON MARION MARSHALL MASON MASSAC MCDONOUGH MCHENRY MCLEAN MENARD MERCER MONROE MONTGOMERY MORGAN MOULTRIE OGLE PEORIA PERRY PIATT PIKE POPE PULASKI PUTNAM RANDOLPH RICHLAND ROCK ISLAND SALINE SANGAMON SCHUYLER SCOTT SHELBY ST CLAIR STARK STEPHENSON TAZEWELL UNION VERMILION WABASH WARREN WASHINGTON WAYNE WHITE WHITESIDE WILL WILLIAMSON WINNEBAGO WOODFORD *   
Number of Acres:   *
Do You Own This Property?    

Please list either your Wild Game and Bird Breeder Permit Number or Game Breeding and Hunting Preserve Area License Number:    

Please list the full names of anyone else that has authorization to use the designated dog training area:


The Dept. of Natural Resources is requesting this informtaion as outlined under the Wildlife Code, Chapter 520. Providing this information is required. Failure to provide any informattion will result in this application not being processed. The Illinois Department of Natural Resources does not discriminate on the basis of race, color, sex, national origin, age or handicap in admission to, or treatment or employment in programs or activities in compliance with the Illinois Human Rights Act, the Illinois Consitiution, the U.S. Civil Rights Act, Section 504 of the Rehabilitation Act, as amended, and the U.S. Constitution.