United States Department of the Interior U.S. FISH AND WILDLIFE SERVICE Wertheim National Wildlife Refuge

340 Smith Road Shirley, New York 11967

Voice: (631) 286-0485 Fax: (631) 286-4003

Dear Hunter,

It is time to apply for the 2019-2020 deer hunts at Wertheim National Wildlife Refuge (Refuge). Wertheim is a 2,688-acre Wildlife Refuge located on Long Island’s south shore that hosts a variety of habitats including woodlands, grasslands, ponds, tidal marshes and bays. Wertheim was established in 1947 for migratory bird conservation, fish and wildlife-oriented recreation, natural resource protection and threatened and endangered species conservation.

Please read all enclosed forms carefully and return your completed hunt application(s) by August 31, 2019 to:

Wertheim National Wildlife Refuge Re: Deer Hunt 340 Smith Road Shirley, NY 11967

For questions concerning the Refuge deer hunt, please contact our office at 631-286-0485 Monday through Friday, 8:00 a.m. - 4:00 p.m. Please be aware that Refuge specific hunt regulations will change for the 2020-2021 hunting season. The changes concern Refuge regulations being in alignment with state hunting regulations, where applicable. These changes will be released in next year’s hunt application package. We look forward to a safe and productive hunting season.

Sincerely,

Refuge Staff

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2019–2020 Deer Hunting Wertheim National Wildlife Refuge

Hunter Orientation

Background Information Wertheim National Wildlife Refuge covers approximately 2,688 acres along the Carmans River. Approximately 1,600 acres of the Refuge provide habitat for white-tailed deer, while the remainder is primarily open water, salt marsh, buildings and roads. Currently, the Refuge population ranges from 50 to 60 deer per square mile, depending on the time of year, and deer movement on/off the Refuge. At higher densities, deer can over browse the available vegetation and, therefore, degrade habitat for other species. Deer-car collisions and deer browsing of ornamental plantings in adjacent residential areas become more serious problems at high deer densities. Our goal is to maintain the deer population at 20 to 30 deer per square mile and the ratio of antlerless to antlered deer at 3:1.

The Refuge seeks to offer a high quality hunting experience. Hunter numbers in the various units are low compared to many places on Long Island. For example, the Refuge expects to have approximately one archer for every 40 acres.

Application Information All hunters are required to complete the enclosed written orientation examination answer sheet and return it along with your hunt application to the Refuge postmarked by August 31, 2019. The orientation exam can be taken only one time each year. All answers can be found in the material contained in this orientation packet.

If you fail to score at least 90% on the written exam, or if you do not return your hunt orientation exam answer sheet, along with your hunt application, postmarked by August 31, 2019, your name will not be entered into the drawing to hunt on the Refuge during the 2019 - 2020 deer season. The sale of permits after the drawing has been discontinued. All hunters must apply by the deadline, August 31, 2019.

General Information Wertheim National Wildlife Refuge is located entirely within Suffolk County and the Town of Brookhaven. Please keep in mind that other members of the public may be using the Carmans River during the hunting season. Extreme caution should be taken when hunting near the river. Refuge nature trails will be closed to non-hunters during the hunting season. If you need to contact our office in case of an emergency, or to report a hunting violation, the phone number to the Wertheim Deer Check Station (631-316-3265), is on your Refuge permit and contact card.

Session is defined as each set of hunt dates: Archery Session 1 is November 7, 8 and 9. Archery Session 2 is November 21 and 22. Archery Session 3 is December 13 and 14. Shotgun Session 1 is January 6 and 7. Shotgun Session 2 is January 23 and 24.

U.S. Fish and Wildlife Service

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Season is defined as all of the hunt dates for that hunt method. Archery season is all archery hunt dates. Shotgun season is all shotgun hunt dates.

In addition to the New York State hunting license, all participating hunters must obtain a Refuge permit. Refuge permits will be issued to those hunters that answer at least 90% of the orientation exam questions correctly (45 out of 50) and are selected during the hunt drawing. Refuge permits are not transferable. Selected hunters who will not be attending their assigned hunt session must notify the Refuge no less than one business day prior to the hunt session. Additionally, permitted hunters are not allowed to bring friends or relatives with them during scouting or hunting days. However, a non-hunting adult with a valid New York State hunting license must accompany a youth hunter, under age 16, during scouting and hunting.

Hunters will be assigned to parking lots based on their hunt unit. Refuge parking permits will be issued to each hunter and must be displayed face up on the dashboard of your vehicle. Hunters may not block access roads. Hunters are required to check in upon first entering the Refuge each day and must check out before leaving at the end of each day. The Refuge entrance gate and parking lots open one hour before sunrise. Please do not block the Refuge entrance gate or Smith Road.

As a reminder for hunters in tree stands, the first thing you should do upon entering a portable tree stand is to fasten your safety harness. The Refuge encourages hunting from tree stands because it provides a safer shooting angle and better visibility. Hunters must remove their tree stand at the end of their assigned hunt session. The Refuge also asks that hunters demonstrate courtesy by not setting up close to another hunter, and not dressing harvested deer in Refuge parking lots or along Refuge trails.

The Refuge encourages hunters to be respectful of the non-hunting public and to be good ambassadors of their sport. Transporting harvested deer uncovered, such as on the hood of your car or uncovered on a trailer hitch cargo rack, does not promote ethical hunting and may foster opposition to deer hunting in the surrounding communities.

During the Refuge shotgun sessions, the southern portion of Unit 3 and all of Unit 5 will be closed to hunting. These closed areas are noted on the enclosed hunt map. The southern portion of Unit 3 will also be marked with red and white striped flagging. Property located south of the red and white flagging is not open to shotgun hunting.

Hunters are responsible for identifying their target before they shoot. It is recommended that hunters do not try to shoot a deer on the run to prevent inflicting a non-fatal wound. If you shoot a deer, you must make every effort to locate it and reduce it to possession.

The application fee is $15.00 per application. This administrative fee is non-refundable, even if you are not selected to hunt. Please include a check or money order payable to the U.S. Fish and Wildlife Service with your application package. Applications must be postmarked or returned to the Refuge by August 31, 2019. Late and/or incomplete applications will not be accepted.

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Scouting All hunting units on the Refuge will be open for scouting between 8:00 a.m. and 4:00 p.m. for selected archery hunters on October 26 and November 30, and for selected shotgun hunters on December 28. Please obey the posted speed limits on the roads. During scouting, hunters must park in designated parking areas, with their Refuge parking permit displayed face up on the vehicle dashboard. Hunters must possess a Refuge hunting permit in order to scout. Vehicles parked illegally will be ticketed and towed if necessary. While you may scout any unit, we encourage you to first scout the unit you are assigned to. Hunters must carry their New York State hunting license and Refuge hunting permit with them during scouting days.

Standby Hunting Hunters who submit their completed hunt application by August 31, 2019, AND successfully pass the written orientation exam (at least 90%), will be eligible to participate as a standby hunter. All hunters who applied for an archery permit and successfully passed the orientation exam (at least 90%) will be eligible to participate as standby hunters during any of the archery sessions. All hunters who applied for a shotgun permit and successfully passed their orientation exam (at least 90%) will be eligible to participate as standby hunters during any shotgun session. To avoid parking lot congestion during scouting days, only hunters selected for a hunt session will be allowed to scout.

Standby hunters may arrive at the Wertheim hunter check station one hour before sunrise. Standby hunters present at the check station will be randomly selected to fill any known openings at this time. One hour after sunrise, standby hunters present at the check station will be randomly selected to fill any remaining empty slots. Standby hunters not selected at the sunrise drawing may continue to wait in the check station parking area. As hunters leave for the day, slots will be randomly filled from the standby hunters present. A standby hunter, who is granted permission to hunt on the first day of a hunt session, will still be a standby hunter on the second day and must wait to be selected before hunting.

Regulations for 2019 – 2020 Deer Hunting 1. Hunters must check in at the Refuge check station at the beginning of each hunt day

and check out at the end of each hunt day, even if no deer were harvested. Hunters whohave not checked in by one hour after sunrise risk losing their spot.

2. Hunters may enter the Refuge no earlier than one hour before the beginning of legalshooting hours and must exit the Refuge no later than one hour after the end of legalshooting hours. If you have a deer down and are not able to get it out of the woodsbefore sunset, you must call the Refuge Deer Check Station at 631-316-3265.

3. The bag limit for archery is three deer per hunter. The bag limit for shotgun is three deerper hunter. Hunters may take either one or two antlerless deer before taking an antlereddeer. Hunters who take one antlerless deer then one antlered deer may take anotherantlerless deer, if time permits. Hunters may choose to take three antlerless deer andforfeit their opportunity to take an antlered deer. Antlerless deer must be checked in atthe Refuge check station prior to shooting an antlered deer. At that time, a RefugeBuck Slip will be issued. You must have a Refuge Buck Slip to take a buck on Refugeproperty. The Refuge does not provide New York State carcass tags. Be sure to supply

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your own NYS tags for the deer you harvest.

4. A hunter without a Refuge buck slip cannot shoot a buck and cannot use someone else’s buck slip and permit to tag it.

5. Upon checking in at least one antlerless deer at the Refuge check station, you will beissued a Refuge buck slip. This Refuge buck slip allows you to harvest one antlered deer on Wertheim National Wildlife Refuge. The Refuge buck slip will be valid for the remainder of the archery season or shotgun season. Please note that Refuge buck slips issued during the archery season will not be valid during the shotgun season. To be eligible to shoot a buck onRefuge property you must also possess a New York State issued antlered deer tag.

6. Hunters can take two or three antlerless deer before checking them in at the Refugedeer check station (an antlerless deer is defined as a deer with no antlers or both antlersless than three inches in length). The bag limit is three deer.

7. Upon kill, hunters must complete a New York State carcass tag for each deer. Tagsmust be attached to deer after hunters reach their vehicle. If you fail to follow these procedures, you will be in violation of both Federal and State hunting laws.

8. Hunters must tag all deer with New York State issued hunting tags per New York State hunting regulations.

9. All deer harvested on the Refuge must be checked in at the official Refuge deer check station. Hunters are also responsible for following New York State hunting regulationsfor checking in deer with the State.

10. The Refuge does not permit the marking of any tree, trail, or other Refuge featurewith flagging, paint, reflective material, or any other substance.

11. Hunters may trim branches up to the diameter of a quarter to place tree stands.

12. Distribution of bait and the hunting over bait is prohibited on the Refuge.

13. Hunters may NOT push or drive deer.

14. Only barbless broadheads are permitted during the archery season. Please refer to thecurrent New York State Hunting and Trapping Regulations handbook for moredetails.

15. Only shotguns firing a single projectile (slugs only, no buckshot) are permittedduring firearms season. Muzzleloaders are not permitted on the Refuge.

16. Hunters must have only shotgun shells loaded with slugs during the shotgun season.

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17. Each hunter may only use one portable deer tree stand and it may be left on the Refuge during your designated hunt session at your own risk. Hunters must attach clearly legible identification on their stands with their name, address, and phone number. The Refuge will not be responsible for any stolen property. Tree stands must be removed from the hunt unit at the end of the hunt session.

18. Hunters selected to hunt in unit 5 MUST hunt from a portable tree stand. Unit 5 is for archery hunters only. If you are unwilling or unable to hunt from a tree stand, please consider this when ranking your hunt unit preferences.

19. You must use a safety harness and belt while hunting from a tree stand.

20. Hunt unit 4 has special access for Disabled Hunters Only at the White Oak Nature Trail. Hunters must carry a Refuge hunt permit before entering this area. Only hunters possessing a state-issued “Permit for Physically Challenged Hunters” are eligible to receive special access to this area. Contact the Refuge office for details, 631-286-0485.

21. Individuals hunting on the Refuge are subject to inspections of permits, licenses, hunting equipment, bag limits, boats, vehicles, and their contents by Federal and/or State Law Enforcement Officers.

22. Shotgun hunters must wear in a conspicuous manner on HEAD, CHEST, and BACK a minimum of 400 square inches of SOLID FLOURESCENT ORANGE clothing. Camouflage Orange alone is NOT permitted.

23. Hunters may not have loaded weapons, including nocked arrows, in the 500-foot no hunt buffer zone (shaded in red on the Refuge hunting map).

24. A licensed, non-hunting adult must accompany hunters under age 16. Hunters age 16 or 17, may be accompanied by a licensed, non-hunting adult, if desired.

25. The sign below marks the no hunting zone on the Refuge. Hunters are responsible for knowing where they are at all times in relation to hunting zones and Refuge boundaries.

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26. Below on the left is a sign with the National Wildlife Refuge System’s blue goosesymbol. This sign is used to mark the Refuge boundaries. On the right, the “AreaBeyond This Sign Closed,” is a Refuge sign that can only be ignored during designatedscouting days and hunting sessions.

REFUGE BOUNDARY SIGN AREA CLOSED SIGN

27. Hunters are required to drive on designated roads and park only in designated parkingareas.

Additional Prohibited Activities • Littering• Use of a spotlight or other artificial light may not be used to locate wildlife• Baiting or hunting over bait, salt, or any attractant• Driving or screwing a nail, spike, or other metal object into a tree or hunting from any tree in which

such an object has been driven• Use or possession of alcoholic beverages• Use of ATVs and/or dirt bikes, or other non-licensed vehicles• Target practice• Camping and campfires• Overnight parking• Searching or removing objects of antiquity including arrowheads, pottery or other items• Searching for or removing plants or animals other than deer from the Refuge• Blocking gates or roadways with vehicles• Pets are not permitted on the Refuge at anytime

Remember, while hunting on the Refuge, you are responsible for knowing and abiding by all State, Federal, and Refuge regulations. Know where you are at all times and respect private property.

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Quota Deer Hunt Application Instructions To ensure your application is fully completed and submitted properly, please review the following instructions:

Select the appropriate form. There is one for archery and another form for shotgun. Hunters can fill out and submit the form for archery, shotgun or both. See number 4 on the forms.

If you would like to apply as a pair, at the top of the page please write in “Pairedwith” followed by your hunting partner’s name. BOTH applicants in the pair must fillout all application materials individually (including the Application Exam AnswerSheet and payment). Paired applications must be submitted in the same envelope. Applications received separately will not be paired.

Number 1 has been completed for you; Name of Refuge: Wertheim National Wildlife Refuge

Numbers 2 and 3: fill out date, name, address, phone number and email informationneatly and completely. The contact information on your application will be used tonotify you, so please print legibly.

Number 4 was completed for you. Make sure you are using the correct form,shotgun or archery. You may apply for shotgun and archery if you areinterested in both hunt methods.

Number 5:• Archery: you have three date choices. Please enter your 1st choice, 2nd

and 3rd from these dates; November 7, 8 and 9 OR November 21 and22 OR December 13 and 14. During the drawing you will be assignedto your preferred session, if slots are available. If your 1st choice is fulland you do not select a 2nd and 3rd choice, we will presume you areunavailable for the other dates and you will not be selected for apermit.

• Shotgun: you have two date choices. Please write January 6 and 7 ORJanuary 23 and 24 as your 1st choice. During the drawing you will beassigned to your preferred session, if slots are available. If your 1stchoice is full and you do not select a 2nd choice, we will presume youare unavailable and you will not be selected for a permit.

Number 6:• Archery: you have four unit choices. Please enter your 1st choice, 2nd, 3rd

and 4th from these unit numbers; 3, 4, 5 or 6. During the drawing you will be assigned to your preferred unit, if space is available. If your 1st choice is full and you do not select other units, we will presume you only want one unit and you will not be selected for a permit.

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• Shotgun: you have three unit choices. Please enter your 1st choice, 2nd and 3rdfrom these unit numbers; 3, 4 or 6. During the drawing you will be assigned to your preferred unit, if space is available. If your 1st choice is full and you do not select other units, we will presume you only want one unit and you will not be selected for a permit.

Number 7: if you are a disabled hunter, please circle “yes”. If neither yes or no are circled, Refugestaff will circle “no”. Only hunters possessing a state-issued “Permit for Physically ChallengedHunters” are eligible. Unit 4 has special access for Disabled Hunters Only at the White Oak NatureTrail. Contact the Refuge office for details, 631-286-0485.

Number 8: please sign the appropriate line or lines.

Checklist for Mailing in Your Application In the envelope: ___ Completed Hunter Orientation Exam Answer Sheet ONLY ___ Quota Deer Hunt Application for archery, shotgun or both ___ Check or Money Order for $15 per application; if you are applying for archery AND

shotgun, you can submit one check for $30 or two checks for $15 each Payable to: U. S. Fish and Wildlife Service

___ Paired hunters: all applications and payments in one envelope ___ Address envelope to:

Wertheim National Wildlife Refuge Re: Deer Hunt 340 Smith Road Shirley, NY 11967

SUBMIT YOUR HUNT APPLICATION NO LATER THAN AUGUST 31, 2019.

Results of the drawing for hunt permits will be available on October 4, 2019. All applicants will be notified by mail with the drawing results. If you have any questions, please contact the Refuge office at 631-286-0485, Monday through Friday, 8:00 a.m. to 4:00 p.m.

U.S. Fish & Wildlife Service Deer Hunt Map

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Unit 3

Unit 4

Unit 6

Unit 3

Unit 5

Source: Esri, DigitalGlobe, GeoEye, Earthstar Geographics,CNES/Airbus DS, USDA, USGS, AEX, Getmapping, Aerogrid, IGN, IGP,swisstopo, and the GIS User Community

72°55'0"W

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U.S. Fish & Wildlife Service Deer Hunt Map

Wertheim National Wildlife Refuge

0 425 850 1,275 1,700 2,125212.5Meters

0 0.25 0.5 0.75 1 1.250.125Miles

1 = 24,000

Archery Only

Archery Only

LegendIA Parking^̀ Check Station^̀ Visitor Center

Refuge BoundaryDeer UnitsRoadForestHerbaceousMarshShrublandWaterNo Hunting Zone

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WERTHEIM NWR 2019-2020 HUNTER ORIENTATION EXAMINATION Return the completed Answer Sheet ONLY with your hunt application.

1. You may use a temporary or portable tree stand. You must:a. Leave it on the Refuge for the entire Refuge hunt season (October –

January).b. Leave it at the base of the tree every nightc. Remove it at the end of your assigned hunt sessiond. All of the above

2. Hunters who harvest at least one antlerless deer will be issued a special Refuge buck slip that will be valid for the rest of archery hunting season OR shotgun hunting season.

TRUE FALSE 3. What time must hunters check in by at the check station on each hunt day in

order not to risk losing their spot?a. Sunriseb. 8:30 amc. One hour after Sunrised. There is no check in time

4. Which sign below is an internal Refuge sign that you can only walk past on thedesignated scouting days and during Refuge hunting sessions? A B C

5. Which of the signs below is used to mark the Refuge’s boundary? A B C

6. Which sign below is used to mark the no hunting buffer zone?

A B C

7. The first thing you must do after entering an elevated tree stand is:a. look around for deerb. haul up your unloaded gunc. attach your safety harnessd. check wind direction

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8. How many antlerless deer must you shoot before taking an antlered deer?a. Noneb. Onec. Twod. Three

9. Are you permitted to push or drive deer from a safety zone?YES NO

10. Are the buck tags attached to your state or NY DEC hunting license the onlytags required for you to shoot a buck at Wertheim NWR? YES NO

11. Are you allowed to hunt on Wertheim NWR property if you do notreceive a score of 90% or higher on this written examination? YES NO

12. What color is the safety zone marked on the Refuge hunt map?a. Red crosshatchb. Blue dotsc. Whited. Orange with black stripes

13. Your parking permit must be displayed face up in a readable fashion on yourvehicle dashboard.

TRUE FALSE 14. Within the 500 foot No Hunt Buffer the following is prohibited:

a. Carrying a loaded weaponb. Discharging a weaponc. Driving or pushing deerd. All of the above

15. Wertheim NWR will issue you a state carcass tag if you need one onthe day of your assigned hunt. TRUE FALSE

16. You are allowed to trim or cut branches:a. Smaller than a quarter in diameterb. Larger than a quarter in diameterc. Whatever size you wantd. You are not allow to cut any branches

17. During shotgun season, you must only have in your possessionshotgun shells loaded with buckshot.

TRUE FALSE 18. Distribution of bait and the hunting over bait are permitted on the Refuge.

TRUE FALSE 19. Archery hunters assigned to unit five (5) must hunt from a portable

tree stand and must aim away from the public road and dwellings.TRUE FALSE

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20. Upon shooting and downing a deer you must:a. Fill out a NY state hunting carcass tagb. Fill out a Refuge hunting carcass tagc. Do nothingd. Wait until you shoot another deer

21. During the Refuge shotgun season, hunters are required to wear:a. A minimum of 400 square inches of solid orange clothingb. A minimum of 200 square inches of solid orange clothingc. No orange clothing is requiredd. An orange hat

22. Hunters are allowed to enter the Refuge 1 hour before legal hunting hours and must leave the Refuge no later than 1 hour after sunset.

TRUE FALSE

23. You are allowed to mark any tree, trail, or other Refuge feature withflagging, paint, reflective material or any other substance.

TRUE FALSE 24. Is it courteous to hunt close to another hunter?

YES NO 25. Hunters may bring dogs onto the Refuge to assist in pushing or driving deer.

TRUE FALSE 26. During scouting days, hunters under 16 years of age are not allowed to

bring a friend or family member that did not apply for the hunt.TRUE FALSE

27. Muzzleloaders, in addition to shotguns, are permitted during the Refuge hunt.TRUE FALSE

28. The bag limit is unlimited antlerless deer per hunting session.TRUE FALSE

29. To avoid wounding deer, it is recommended that you not shoot at deer that areon the run.

TRUE FALSE 30. Youth hunters must always be under immediate supervision of a non-hunting,

licensed adult.TRUE FALSE

31. If you down a deer at sunset, you are allowed to continue lookingfor it beyond legal hunting hours without notifying the deer checkstation.

TRUE FALSE 32. If you get sick and are unable to hunt during your assigned hunting

session, you can give your Refuge hunting permit to a friend andallow them to hunt in your place.

TRUE FALSE

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33. While hunting at Wertheim NWR, you are not allowed to:a. Drive or push deerb. Shoot a buck and use your friend’s Refuge buck permitc. Shoot wildlife other than deerd. All of the above

34. Hunters must carry a state-issued “Permit for Physically Challenged Hunters” tobe eligible to access unit 4’s Disabled Hunters Only at the White Oak NatureTrail. TRUE FALSE

35. If you harvest Refuge deer, are you required to check it in at the Refuge checkstation?

YES NO 36. What County is Wertheim NWR in?

a. Nassaub. Suffolkc. Brookhavend. Queens

37. All archery applicants who pass their exam will be eligible to participate asstandby hunters during all archery sessions. All shotgun applicants who passtheir exam will be eligible to participate as standby hunters during all shotgunsessions. TRUE FALSE

38. Hunters must check in and check out each day even if no deer were harvested.TRUE FALSE

39. Hunters will be issued a permit to shoot an antlered deer only after they havechecked in at least one antlerless deer.

TRUE FALSE 40. Is it permitted to use or construct a permanent tree stand or install a nail, spike,

or other metal object into any tree on the Refuge? YES NO

41. Does hunting from a tree stand provide a safer shooting angle and bettervisibility?

YES NO 42. Hunters must attach their name, address, and phone number to their portable

tree stands.TRUE FALSE

43. Hunters are allowed to dress their deer in the Refuge parking areas and alongtrails.

TRUE FALSE 44. Is the use or possession of alcoholic beverages allowed while hunting?

YES NO 45. Hunters must limit vehicle driving to designated access roads and park only in

designated areas.TRUE FALSE

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46. Hunters will be checked for valid permits, licenses, hunting equipment etc. byFederal and/ or State Law Enforcement Officers. TRUE FALSE

47. An antlerless deer is defined as any deer with no antlers or both antlers lessthan three inches in length.

TRUE FALSE 48. During the Refuge shotgun season, hunters are required to wear:

a. A minimum of 400 square inches of solid orange clothingb. A minimum of 200 square inches of solid orange clothingc. No orange clothing is requiredd. An orange hat

49. A standby hunter, who is granted permission to hunt on the first day of a huntsession, will still be a standby hunter on the second day and must wait to beselected before hunting.

TRUE FALSE 50. The following hunters are allowed to scout:

a. All hunters who applied for the hunt and passed the exam (90% orbetter)

b. Standby Hunters Onlyc. Hunters selected for a hunt session Onlyd. Both Standby Hunters AND Hunters selected for a hunt session

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Exam Answer Sheet Please return ONLY the completed ANSWER SHEET.

Name of Applicant Signature

By signing this exam, you are stating that you have read and understand the information enclosed in the Wertheim NWR hunter orientation packet. Please return your completed orientation exam answer sheet and hunt application no later than August 31, 2019.

1. 20. 39.

2. 21. 40.

3. 22. 41.

4. 23. 42.

5. 24. 43.

6. 25. 44.

7. 26. 45.

8. 27. 46.

9. 28. 47.

10. 29. 48.

11. 30. 49.

12. 31. 50.

13. 32.

14. 33.

15. 34.

16. 35.

17. 36.

18. 37.

19. 38.

Payment Required

C M ent Type:

Personal Check ashier’s Check oney Order Other:

: ________________________________________________________________________________

___Print guardian name and signature here

----------------------------------------------------------------------------------------------------------------------------------------------------------------

FWS Form 3-2354 (Rev. 02/2018) U.S. Fish and Wildlife Service

OMB Control. No. 1018-0140 Expiration Date 07/31/2021

QUOTA DEER HUNT APPLICATION National Wildlife Refuge System

Follow instructions in the refuge hunt publication; not all fields may be required. Read and comply with all refuge regulations, including application deadlines.

1. Name of Refuge: _____________________________ 2. Date of Application: _____________________

Full Legal Name: _________________________________________________________________________

Mailing Address: ________________________________________________________________________

City: _____________________________ State: ______________________ Zip Code: _________________

Area Code/Phone No: ____________________________________________________________________

Email Address: __________________________________________________________________________

Method: ________________________________________________________________________________

Hunt Date Choices 6. Hunt Location Choices

1st Choice: ______________________________ 1st Choice: ______________________________

2nd Choice: ______________________________ 2nd Choice: ______________________________

3rd Choice: ______________________________ 3rd Choice: ______________________________

4th Choice: ______________________________ 4th Choice: ______________________________

5th Choice: ______________________________ 5th Choice: ______________________________

Special Hunt: ___________________________ 7A. Youth Hunt Only: Age Limit at Time of Hunt: ____

I have read and understand the refuge hunt regulations and agree to abide by the regulations governing hunting on the refuge.

________________________________________ ________________________________________________

3.

4.

5.

7.

8.

Hunter Signature (required for hunters less than 18 years old)

FOR OFFICE USE ONLY

Date Received: ___________________________

Payment Exempt/No Fee

Payment Amount: __

Paym

______________________

Notes

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FWS Form 3-2354 (Rev. 02/2018) U.S. Fish and Wildlife Service

OMB Control. No. 1018-0140 Expiration Date 07/31/2021

NOTICES

All information you provide will be considered in reviewing this application. False, fictitious, or fraudulent statements or representations made in the application may be grounds for revocation of the permit and may be punishable by fine or imprisonment (18 U.S.C. 1001).

PRIVACY ACT STATEMENT

Authority: The information requested is authorized by the National Wildlife Refuge System Administration Act (16 U.S.C. 668dd-ee) as amended and the Refuge Recreation Act (16 U.S.C. 460k – 460k-4).

Purpose: The collection of contact information is to verify that the individual has an eligible permit to hunt on one of the National Wildlife Refuges that is designated for deer hunting.

Routine Uses: The individual’s contact information may be used to verify permit status, provide permittees with permit-related information, and monitor waterfowl hunt activities conducted under a permit. More information about routine uses can be found in the System of Records Notice, Permits System, FWS-21.

Disclosure: Providing the information is required as a condition of maintaining a Federal permit under the National Wildlife Refuge System Administration Act. Failure to disclose the requested information may be sufficient cause for revocation of the permit. If the information indicates a violation of a statute, regulation, rule, order or license, whether civil, criminal, or regulatory in nature, the information may be transferred to the appropriate Federal, State, local or foreign agency charged with investigating or prosecuting such violations.

PAPERWORK REDUCTION ACT STATEMENT

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to provide the refuge managers the information needed to decide whether or not to allow the requested use, and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. The information that you provide is voluntary; however, submission of the requested information is required to evaluate the qualifications, determine eligibility, and document permit applicants. Failure to provide all required information is sufficient cause for the U.S. Fish and Wildlife Service to deny a permit. We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned OMB Control No. 1018-0140.

ESTIMATED BURDEN STATEMENT

Public reporting for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, MS: BPHC, Falls Church, VA 22041-3803, or via email at Info_Coll@fws.gov. Please do not send your completed application to this address.

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