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(REQUIRED BY SEC. 26-45 OF THE GENERAL STATUTES) (State of Connecticut/Department of Administrative Services)

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BAIT DEALER’S REPORT FOR THE YEAR ENDING DECEMBER 31, 20____
(REQUIRED BY SEC. 26-45 OF THE GENERAL STATUTES)
Name: _______________________________________Address: _____________________________________ ____________________________
Street Town
Bait Dealer’s License Number: __________________________________
DATES BAIT SPECIES WERE ACQUIRED AND SOURCES OF SUPPLY
Date Bait Species
Name of Person
From When Acquired
Address
Street & Town
SUMMARY OF BAIT SPECIES ACQUIRED AND SOLD
BAIT SPECIES
NUMBER
ACQUIRED
NUMBER
SOLD
Golden Shiner or “Pond Shiner”
Common or Red Fin Shiner
Fallfish
Creek Chub
Spotteil Shiner or “River Bait”
Mummichog or Millifish
Common Sucker
Other Minnows: List by species
Frogs
Perchbugs
Helgramites
Crawfish
This report must be mailed to the Dept. of Environmental Protection, License and Revenue Unit, 79 Elm Street, Hartford, CT,
06106, within (30) days following expiration date of license.
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(REQUIRED BY SEC. 26-45 OF THE GENERAL STATUTES) (State of ConnecticutDepartment of Administrative Services)

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Completed 13 August 2020

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