Semi-Wild Shooting Preserve Permit Renewal Form
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3State of New Jersey
Department of Environmental Protection
Division of Fish and Wildlife
Captive Game Permits
26 Route 173 West
Hampton NJ 08827
SEMI-WILD SHOOTING PRESERVE
PERMIT RENEWAL FORM
License Fee: $77.00
Permit Number: _______________________________________
Name of Club or Organization: ___________________________________________________________
Contact Person _______________________________________________________________________
Address ____________________________________________________________________________
City __________________________________________State __________ Zip Code ______________
Social Security # _____________________________ DOB: __________________________________
Day Phone: _________________________________ Home Phone: ____________________________
E-mail Address: ______________________________________________________________________
Preserve Location (Street Address): _______________________________________________________
Township: ______________________________ County: ___________________ Total Acres: ________
Block/Lot numbers: ____________________________________________________________________
Description of Boundaries: ______________________________________________________________
Please check one:
I am the owner __________
Lease holder _________
Name of Property Owner/Lessor: _________________________________________________________
Mailing address of Owner: ______________________________________________________________
Telephone Number of Owner: __________________________________________________________
Are there any changes in property that were hunted last year? ______Yes
_______No
If yes, explain changes: _______________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Number of birds to be released:
____________ Pheasants
____________ Quail
____________ Chukar Partridge
0
____________ Hungarian Partridge
____________ Total Birds
Game Bird Supplier Permit Number: ______________________________
Please send __________ # of tags @ $.15 ea.
Total tag amount $_______________
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