"New York State Angler Achievement Awards Program Official Entry Form" - New York

New York State Angler Achievement Awards Program Official Entry Form is a legal document that was released by the New York State Department of Environmental Conservation - a government authority operating within New York.

Form Details:

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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New York State Department of Environmental Conservation.

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Download "New York State Angler Achievement Awards Program Official Entry Form" - New York

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N
Y
S
A
A
A
P
EW
ORK
TATE
NGLER
CHIEVEMENT
WARDS
ROGRAM
O
E
F
FFICIAL
NTRY
ORM
Section A: Entry Category
Fish is being entered in
Catch and Release Category
Annual Award Category
State Record
(check one)
(complete sections B, C, G)
(complete sections B, C, D, E, G)
(complete sections B, C, D, E, F, G)
Section B: Angler Information
Name of Angler:
Phone:
Address:
Date:
City/Town:
State:
Zip Code:
Email:
Section C: Catch Information
Fish Species:
Date of Catch:
Length:
Kept
Released
Time of Catch:
AM
PM Lure/Bait Used:
Lure Color/Size:
Name of Water Body:
County:
Nearest Town:
Description of how fi sh was caught:
Section D: Weight Information (Annual Award or State Record entries only)
Weights taken on personal/handheld scales are ineligible.
Name of Weigher:
Business Name:
Weight:
lbs.
oz.
Address of Business:
Phone:
City/Town:
State:
Zip Code:
Today’s Date:
Scale Certifi cation Number:
Date Last Certifi ed:
Weigher Signature:
Section E: Witness Verifi cation (Annual Award or State Record entries only)
Name of Witness:
Witness Signature:
Address of Witness:
City/Town:
State:
Zip Code:
Date:
Section F: Species Information (State Record entries- to be completed by a DEC Fisheries or Designee)
I have examined the fi sh described above and confi rm that it is a:
Name of DEC Fisheries Biologist or Designee:
Signature:
Date:
Section G: Angler Signature (all entries) and Notarization (State Record entries only)
I hereby swear that the information provided on this form is true and correct to the best of my knowledge and that the taking of the fi sh described above was in ac-
cordance with the rules of the New York State Angler Achievement Awards Program. Furthermore, I release to the New York State Department of Environmental
Conservation the right to use the above information and any enclosed photographs for promotional purposes, although I understand that this does not restrict my use
of the same information and photographs.
Signature of Angler (all entries):
Sworn before me this day of:
Year:
Signature of Notary (State Record entries only):
Notary Seal (State Record entries only)
Miscellaneous Notes
Print Form
N
Y
S
A
A
A
P
EW
ORK
TATE
NGLER
CHIEVEMENT
WARDS
ROGRAM
O
E
F
FFICIAL
NTRY
ORM
Section A: Entry Category
Fish is being entered in
Catch and Release Category
Annual Award Category
State Record
(check one)
(complete sections B, C, G)
(complete sections B, C, D, E, G)
(complete sections B, C, D, E, F, G)
Section B: Angler Information
Name of Angler:
Phone:
Address:
Date:
City/Town:
State:
Zip Code:
Email:
Section C: Catch Information
Fish Species:
Date of Catch:
Length:
Kept
Released
Time of Catch:
AM
PM Lure/Bait Used:
Lure Color/Size:
Name of Water Body:
County:
Nearest Town:
Description of how fi sh was caught:
Section D: Weight Information (Annual Award or State Record entries only)
Weights taken on personal/handheld scales are ineligible.
Name of Weigher:
Business Name:
Weight:
lbs.
oz.
Address of Business:
Phone:
City/Town:
State:
Zip Code:
Today’s Date:
Scale Certifi cation Number:
Date Last Certifi ed:
Weigher Signature:
Section E: Witness Verifi cation (Annual Award or State Record entries only)
Name of Witness:
Witness Signature:
Address of Witness:
City/Town:
State:
Zip Code:
Date:
Section F: Species Information (State Record entries- to be completed by a DEC Fisheries or Designee)
I have examined the fi sh described above and confi rm that it is a:
Name of DEC Fisheries Biologist or Designee:
Signature:
Date:
Section G: Angler Signature (all entries) and Notarization (State Record entries only)
I hereby swear that the information provided on this form is true and correct to the best of my knowledge and that the taking of the fi sh described above was in ac-
cordance with the rules of the New York State Angler Achievement Awards Program. Furthermore, I release to the New York State Department of Environmental
Conservation the right to use the above information and any enclosed photographs for promotional purposes, although I understand that this does not restrict my use
of the same information and photographs.
Signature of Angler (all entries):
Sworn before me this day of:
Year:
Signature of Notary (State Record entries only):
Notary Seal (State Record entries only)
Miscellaneous Notes
Print Form