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DECALS ID # THIS LICENSE IS TO BE USED: Prior to Oct 1 On or after Oct 1 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION COMPUTERIZED SPORTING LICENSE APPLICATION FIRST NAME Circle license
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00 Four-Day Fishing (Date) OTHER INFORMATION I am the legal owner of the property I am the legal registered owner of the property I was notified of a fish kill that occurred on the property I will attend quarterly meetings of the Department of Environmental Conservation at the public office address provided in the attached Notice of Public Meetings I was not notified of a fish kill on the property I have had a Department of Environmental Conservation representative visit the property and check my property for any public nuisance signs that have appeared on the property I have received a letter of intent for the establishment of one or more recreational fish hatchery within my property and the fish that are being raised, transported, bred and released shall be protected under section 1305(b) of the Fish and Aquatic Life Protection Act. I have obtained a temporary New York State fishing license. I am the legal owner of the property I intend to use for one or more of the following activities while on the property: Fishing with any device (other than a rod and reel) (except a fish finder), fishing on or in any water of this Department's jurisdiction other than the tidal range, and, fishing on or in the tidal range. DETAILS FOR THIS LICENSE: A. The application must be completed and received by the Department no later than October 1, 2018, B. The application shall identify on its face the applicant(s) and any other persons and legal entities to which the proposed activity will apply. The applicant(s) must have no prior, existing, or planned activity involving fish other than angling C. The applicant(s) must fill a License Application form provided on the License Application page and pay the required fees on that page D. An environmental impact statement will be prepared for the proposed activity and submitted to the Division of Fisheries the prior date of application in accordance with the Division's regulations. E. The Department will process applications in accordance with the Administrative Procedure Act, Part 2. I agree that the application will be processed in accordance with Title 31 of the New York Administrative Code I agree to abide by all applicable laws and regulations. F. In consideration of this license, the Department may issue me, by first class mail, a license for one or more recreational fishing sites which must be placed in an area designated in the application for at least two weeks prior to the completion of the application.

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