"Application to Operate a Regulated Shooting Ground" - Vermont

Application to Operate a Regulated Shooting Ground is a legal document that was released by the Vermont Department of Fish & Wildlife - a government authority operating within Vermont.

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Download "Application to Operate a Regulated Shooting Ground" - Vermont

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Vermont Fish & Wildlife Department
Application Type:
1 National Life Drive, Davis 2
Regulated
Montpelier, VT 05620-3702,
802-828-1000
Shooting
STATUTORY AUTHORITY: 10 V.S.A. §§ 5217-5223 10 V.S.A. App § 13
Ground
Application to Operate a Regulated Shooting Ground
Permit Fee $100.00 (annual fee)
1.
Permittee/Applicant Name
___________________________________________
Business Name: _________________________________________________________
Principal Officer (CEO) of Business: _______________________________________
Physical Address/Town/St/Zip: ___________________________________________
Mailing Address (if different):
___________________________________________
Telephone(s): ______________________________________
E-Mail:
_______________________________________
2.
Property Owner Name & Contact Information
_______________________________________________________________________
_______________________________________________________________________
3.
Property Description: (provide address and description. Attach map or sketch that includes
approximate distances, and identifies highways and other landmarks.)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
4.
Acreage of proposed area (minimum 200 acres) _________. This area is approximately:
Woodland _____%
Cleared _____%
Shrubland _____%
Water _____%
5.
Species to be released (regulation 10 V.S.A. App. § 13 allows only pheasant, quail, chukar
and Hungarian partridge and mallard duck):
______________________________________________________________________
Note: A wildlife importation permit is required to import wild birds into Vermont.
Vermont Fish & Wildlife Department
Application Type:
1 National Life Drive, Davis 2
Regulated
Montpelier, VT 05620-3702,
802-828-1000
Shooting
STATUTORY AUTHORITY: 10 V.S.A. §§ 5217-5223 10 V.S.A. App § 13
Ground
Application to Operate a Regulated Shooting Ground
Permit Fee $100.00 (annual fee)
1.
Permittee/Applicant Name
___________________________________________
Business Name: _________________________________________________________
Principal Officer (CEO) of Business: _______________________________________
Physical Address/Town/St/Zip: ___________________________________________
Mailing Address (if different):
___________________________________________
Telephone(s): ______________________________________
E-Mail:
_______________________________________
2.
Property Owner Name & Contact Information
_______________________________________________________________________
_______________________________________________________________________
3.
Property Description: (provide address and description. Attach map or sketch that includes
approximate distances, and identifies highways and other landmarks.)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
4.
Acreage of proposed area (minimum 200 acres) _________. This area is approximately:
Woodland _____%
Cleared _____%
Shrubland _____%
Water _____%
5.
Species to be released (regulation 10 V.S.A. App. § 13 allows only pheasant, quail, chukar
and Hungarian partridge and mallard duck):
______________________________________________________________________
Note: A wildlife importation permit is required to import wild birds into Vermont.
Vermont Fish & Wildlife Department Application for Regulated Shooting Ground Permit
page 2 of 2
6.
Required Attachments:
___Application fee: $100 to payable to Vermont Fish & Wildlife Department
___Map/Sketch: showing the location of the proposed Regulated Shooting Ground.
7. Certification by signature: I have read and understand the applicable statues and
regulations (10 V.S.A. §§5217-5223 10 V.S.A. App § 13). I hereby affirm, under penalty of
perjury, that the information, as well as any exhibits, documentations, and maps, are truthful
to the best of my knowledge, that I am not delinquent in any obligation to pay child support
or that I am in good standing with respect to any unpaid judgment issued by the judicial
bureau or district court for fines and penalties for a civil violation or criminal offense. I also
understand that false statements made on this application are punishable pursuant to 10
V.S.A. §4267 of Vermont state law.
Signature: _____________________________
Date: ______________
Submit completed application via email (preferred) to lucy.herring@vermont.gov or mail to
“Permit Specialist” c/o VFWD at the address at the top of this form. Make application fee
checks payable to “Vermont Fish & Wildlife Department”
Allow up to 30 days following the determination that the application is complete for
application processing.
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