Landowner Only Mail Order Application - Odfw Controlled Hunts - 2016
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1Certification of resident status required for Oregon resi-
Issue Date ______________
2016
dents on mail orders and fax orders. Fax this application
to 503-947-6113 OR 503-947-6117. We are unable to
Initials ________________
accept telephone orders.
LANDOWNER ONLY
LOP REGISTRATION NUMBER
MAIL ORDER
MARK STATUS:
Non-resident
DEPARTMENT USE ONLY
MAY
PHOTOCOPIES OF THIS PAGE
BE USED.
Resident
Driver License #______________
MAIL TO: ODFW Controlled Hunts
4034 Fairview Drive SE Salem OR 97302
LAST NAME (Please Print)
FIRST
MI
Social Security Number (Required)
MAILING ADDRESS
Hunter/Angler ID Number
CITY
STATE
ZIPCODE
Date of Birth (MM-DD-YYYY)
• If you are resubmitting a copy of this form due to a change, write “This is a revision/
copy of the original order” at the top of the copy to prevent duplicate charges. If you
MALE
FEMALE
have already sent your application fee when you originally applied in the 2015 Big
resend
Game Drawing for the same hunt series, do not
payment.
QUESTIONS? CALL 503-947-6101
• License, tag, application and agent fees are NOT REFUNDABLE.
Mark choice(s) and fill in fee(s):
CONTROLLED HUNT APPLICATIONS
$_______ Resident Hunting, Combination License
To apply for controlled hunt(s), you must purchase
or Sports Pac.
a hunting license at this time, or indicate your 2014
$_______ Non-Resident Hunting License
license above.
$_______ Controlled Hunt Tag
___________
Check each desired hunt series type. List the hunt
(specify no)
$_______ Resident General Season Black Bear
choice in the LOP Choice box that corresponds with the
$_______ SW Additional Black Bear
landowners tag distribution form for that hunt series.
$_______ Nonresident General Season
Application fee is $8.00 per hunt series.
Black Bear (specify area)_________________
LOP Choice
$_______ Nonresident Additional
Controlled Buck Deer
Black Bear (specify area)_________________
(100 series)
$ _______
$_______ General Season Cougar
$_______ Additional Cougar
Controlled Elk
(200 series)
$ _______
$_______ Deer
Western Oregon Centerfire
Controlled Pronghorn Antelope
Bow or Controlled Hunt_________________
(400 series)
$ _______
$_______ Elk
Centerfire (specify season)__________
Controlled Antlerless Deer
Bow or Controlled Hunt_________________
(600 series)
$ _______
$_______ $25. Manditory Hunter Reporting Fee
Landowner Reg. #__________
General Season Elk: Cascade; Rocky Mtn 1st or 2nd season;
Coast 1st or 2nd season, or Bow. Please specify your choice.
Landowner Name __________________
Sub total
$
______________ plus $2..00 Shipping and Handling Fee
Grand Total $
_________________
PAYMENT METHOD: (PLEASE DO NOT SEND CASH)
Discover
Check/Money Order to ODFW enclosed or MasterCard Visa
Credit Card number____________________________________________________________Exp. Date_______________ CVC # ____________
Signature ____________________________________________________________________
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