Non-Resident Sporting License Application - New York State Department Of Environmental Conservation

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DECALS ID # ___ ___ ___ ___ ,
___ ___ ___ ___ ,
___ ___ ___ ___
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
NON-RESIDENT
SPORTING LICENSE APPLICATION
FIRST NAME
MI
Circle license type(s) you are applying for and circle fee:
LICENSE TYPE - NON-RESIDENT
LAST NAME
Bear Tag - Need Big-Game, Bowhunting, Muzzleloading
or Super Sportsman Privilege
$ 50.00
Big Game - (Deer Only)
$140.00
STREET ADDRESS
Bowhunting
$140.00
Fishing - Season
$ 70.00
CITY
STATE
ZIP CODE
Fishing (One day)
(Date_______________)
$ 15.00
Fishing (Seven day)
COUNTY
(Beginning Date_____________Ending_____________)
$ 35.00
Jr. Bowhunting (14-15)
$
9.00
HOME TELEPHONE NUMBER WORK TELEPHONE NUMBER
Jr. Hunting (12-15)
$
5.00
Muzzleloading (14+)
$140.00
Recreational Marine Fishing Season
$ 15.00
DATE OF BIRTH
AGE
SEX
Recreational Marine Fishing (One day)(Date___________)
$
5.00
M
F
Mo
Day
Yr
HEIGHT
Recreational Marine Fishing (Seven day)
EYE COLOR
(Beginning Date__________Ending__________)
$ 10.00
ft.
in.
Small Game
$ 85.00
CERTIFICATION
Super Sportsman (Small & Big Game, Fishing,
Muzzleloading, Bowhunting & Turkey Permit)
$280.00
I hereby affirm under penalty of perjury that information provided
on this form is true to the best of my knowledge and belief. False
Trapping
$310.00
statements are punishable as a Class A misdemeanor pursuant to
Turkey Permit - Need Small-Game Privilege
$ 50.00
Section 210.45 of the Penal Law.
OTHER SALES
Conservationist (Subscription only)
$ 10.00
X______________________________________
Conservation Patron (Conservationist and Habitat Stamp)
$ 12.00
SIGNATURE
Habitat Stamp (Donation to Habitat Account,no pin available) $
5.00
CREDIT CARD TYPE
Trail Supporter Patch
$
5.00
Lifetime Privilege Card (Replacement)
$
5.00
VISA
MASTERCARD
AMERICAN EXPRESS
Sportsman Education Certificate (if NY Certified)
$
1.00
Venison Donation Coalition(amount donated here)
$
DISCOVER
CREDIT CARD NUMBER
Donation to Conservation Fund (amount donated here)
$
EXPIRATION DATE
TOTAL FEE
$
DEER MANAGEMENT PERMIT
APPLICATION FEE:
FREE TO LIFETIME SPORTSMAN LICENSES PURCHASED BEFORE 10/01/09.
FREE TO HOLDERS OF A NON-RESIDENT JR. HUNTING AND NON-RESIDENT JR. BOWHUNTING LICENSE.
ALL OTHER APPLICANTS MUST PAY A $10.00 NON-REFUNDABLE APPLICATION FEE
If you wish to apply as a landowner (50 or more acres of
Deer Management Permits - Fill in WMU you wish to apply
for. You may apply for up to 2 DMPs. They may be in the
land within a WMU), fill in your tax map ID number here:
same or different WMUs.
_____________________________________________
1st Permit WMU__________
2nd Permit WMU__________
SWIS code here:___________________________________

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