On or before January 31st of each year, every person to whom a domesticated game breeder’s license has been issued shall report the following to the department on a form provided by the department:

1. (a) The total number of each species of game birds and mammals killed, sold, or shipped during the preceding year.
2. (b) The names of the persons to whom such game birds or mammals were sold or shipped.
3. (c) The name of the person in whose presence such game birds or mammals were tagged.

4. (d) A complete list of the game birds and mammals held in his possession at the time the report is made.

   Such report shall be verified by the affidavit of the licensee.