Form CE-22 "Application for Nursing Home Facility Fishing Permit" - Idaho

What Is Form CE-22?

This is a legal form that was released by the Idaho Department of Fish and Game - a government authority operating within Idaho. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2011;
  • The latest edition provided by the Idaho Department of Fish and Game;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CE-22 by clicking the link below or browse more documents and templates provided by the Idaho Department of Fish and Game.

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Download Form CE-22 "Application for Nursing Home Facility Fishing Permit" - Idaho

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$34.75
CE-22
Permit expires December 31 of current year
01/2011
State of Idaho
Department of Fish and Game
APPLICATION FOR
NURSING HOME FACILITY FISHING PERMIT
(Eligible facilities include intermediate care facilities providing 24 hour skilled nursing care, assisted living
facilities providing 24 hour extensive assistance, and skilled nursing facilities providing 24 hour skilled
nursing care).
Name of Facility:
Contact Name
Address
City
State
Zip
Federal Tax ID #
Telephone No.
Please complete, sign, date, and return this application along with a payment of $34.75, a log of the
residents at said facility, and copy of the facility’s Health and Welfare certificate to the nearest Fish
& Game office.
In conformance with Section 36-409(m), Idaho Code, and the powers vested in the Director of the
Idaho Department of Fish and Game, permission is hereby requested for the residents of the
_________________________________________________________ to take fish during open
season in accordance with other provisions of the law.
It is understood that the head of the facility having custody of said residents hereby recommends
the issuance of this permit and agrees to assume full responsibility for and control over said
resident(s) while said permit is being used.
Only those residents of the facility will be allowed to fish on this permit. All fishing privileges are
automatically revoked for any individual on this group permit, if said individual is dismissed from
nursing care.
PERMIT APPLIED FOR AND PROVISIONS
IDAHO DEPARTMENT OF FISH AND GAME
THEREOF ACCEPTED BY:
Virgil Moore, Director
By
Superintendent of Facility
Date
THIS SECTION TO BE COMPLETED BY ISSUING FISH & GAME OFFICE
Permit No. Issued
Issued By:
Vendor No.
Date Issued
$34.75
CE-22
Permit expires December 31 of current year
01/2011
State of Idaho
Department of Fish and Game
APPLICATION FOR
NURSING HOME FACILITY FISHING PERMIT
(Eligible facilities include intermediate care facilities providing 24 hour skilled nursing care, assisted living
facilities providing 24 hour extensive assistance, and skilled nursing facilities providing 24 hour skilled
nursing care).
Name of Facility:
Contact Name
Address
City
State
Zip
Federal Tax ID #
Telephone No.
Please complete, sign, date, and return this application along with a payment of $34.75, a log of the
residents at said facility, and copy of the facility’s Health and Welfare certificate to the nearest Fish
& Game office.
In conformance with Section 36-409(m), Idaho Code, and the powers vested in the Director of the
Idaho Department of Fish and Game, permission is hereby requested for the residents of the
_________________________________________________________ to take fish during open
season in accordance with other provisions of the law.
It is understood that the head of the facility having custody of said residents hereby recommends
the issuance of this permit and agrees to assume full responsibility for and control over said
resident(s) while said permit is being used.
Only those residents of the facility will be allowed to fish on this permit. All fishing privileges are
automatically revoked for any individual on this group permit, if said individual is dismissed from
nursing care.
PERMIT APPLIED FOR AND PROVISIONS
IDAHO DEPARTMENT OF FISH AND GAME
THEREOF ACCEPTED BY:
Virgil Moore, Director
By
Superintendent of Facility
Date
THIS SECTION TO BE COMPLETED BY ISSUING FISH & GAME OFFICE
Permit No. Issued
Issued By:
Vendor No.
Date Issued
Date
No.
Name
Gender Height Weight
of
Birth
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
All fishing privileges are automatically revoked for an individual listed above on this group
permit, if said individual is no longer a resident of said facility.
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