Hunting Method Exemption Physician'S Statement Of Eligibility - Missouri Department Of Conservation Page 2
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2Dear Applicant and Physician:
With a change in regulation, the accompanying form was developed to streamline and enhance the process of
acquiring a hunting method exemption. The current rule requires the applicant to ensure that all information
on the form is completed.
All blocks within the form must be completed to validate the exemption portion
that the applicant keeps. Any information omitted on the document, or failure to return the top portion of the
form to the Department of Conservation, will invalidate the hunting method exemption.
The process follows:
• The applicant completes all information in Section A. The applicant’s signature is required along with
his/her name, address and Zip code on the removable carry document at the bottom of the form.
• The physician completes all information in Section B and C. The physician’s signature and date are
required next to indicators. The physician must also sign and enter date of issue on the removable
carry document at the bottom of the form.
• Please place the top portion of the form in an envelope and mail to:
Protection Division
Missouri Department of Conservation
P.O. Box 180
Jefferson City MO 65102-0180
Please Note: There no longer is a permanent status exemption available. This change will allow more accurate
record keeping.
All exemptions will require another form to be submitted at the expiration of the temporary
(6 mos, 1 yr, 2 yr, 3 yr, 5yr) exemption. Please remember that all information must be on the detachable carry
document, and the top portion of the form must be mailed in ten (10) days after the doctor signs it for it to be
valid.
PLEASE NOTE: Stationary Vehicle—This will allow you to hunt wildlife from a stationary vehicle during
the prescribed open seasons. You should be aware that state law prohibits shooting from or across a public
road, so any hunting you do must be from a vehicle not parked on such a road. You are not allowed to
hunt on public lands where area regulations prohibit vehicles nor on private lands without the landowner’s
permission. Permission to utilize vehicles to hunt off road on Department lands must be obtained from the
particular area manager of the area you desire to hunt in this manner. No blanket statewide permits are
available to allow this on MDC land.
Thank you for your attention to these documents and we hope that you have many years of enjoyment while
hunting in the great State of Missouri. If you have questions, please call 573-522-4115, ext. 3267.
SPECIAL NOTE: Missouri Statute 252.160. Fraudulently Securing
3CSR10-7.410 para. (O) Any properly licensed person with
license. Any person who shall obtain or cause to be issued any
disabilities, as defined in this Code, may hunt and take wildlife
certificate, license, or privilege from this state or any political
from a stationary vehicle, provided while hunting s/he carries a
subdivision thereof, or from any licensing or certifying organization
physician’s statement provided by the department and signed
authorized to certify or license by the laws of this state, by any deceit,
by a licensed physician which certifies the person has either a
shall, upon conviction, be deemed guilty of misdemeanor.
permanent or temporary disability which qualifies him/her to hunt
from a stationary vehicle. This disabled person shall provide a copy
This authorization does not waive requirements that you have
of the signed physician’s statement to the department within ten
proper hunting permits, and that you abide by limits and other
(10) days of receiving the exemption.
requirements of the regulations and the trespassing laws of the
State of Missouri.
NOTE: Any person who has been convicted of wildlife violations
within the past five years may be considered ineligible for a special
3CSR10-5.216 para. (4) Suspension, revocation or denial of a permit
hunting method exemption. Any subsequent wildlife convictions
or privilege for cause under sections (1) and (2) of this rule shall
include the concurrent revocation of any method exemption.
may cause this privilege to be rescinded.
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