2016 resident gratis and nonresident landowner ...you can also apply for your resident gratis or...
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2016 RESIDENT GRATIS AND NONRESIDENT LANDOWNER(preferential landowner) DEER LICENSE APPLICATIONNorth Dakota Game and Fish DepartmentLicensing Division, SFN 6108
PLEASE SEE RESTRICTIONS ON BACK OF APPLICATION. (If you need any assistance in filling out this application, contact the N.D. Game & Fish Department.)INFORMATION IN THIS SECTION SHOULD BE COMPLETED IN ITS ENTIRETY BY PERSON WHO WILL USE LICENSE.An individual having a RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE may also apply for a bow season license and a muzzleloader season license. An individual may use the RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE during the deer bow, deer gun, and muzzleloader seasons until license is filled.
Please provide us with your three line address. Press firmly and print legibly to avoid delays.
Birthdate _______ ______ ______ ______________________________________ ____________ ____________ (mo) (day) (yr) Social Security Number (required, see back of form) Sex Age
Mail this entire 2 part form to:Deer Lottery – NDGFD
100 N. Bismarck ExpresswayBismarck, ND 58501-5095
Phone (701) 328-6300
LAST NAME FIRST MIDDLE
ADDRESS
CITY STATE ZIP
UNIT(S) WHERE LAND IS LOCATED (see map)
TO TRANSFER ELIGIBILITY CHECK THE BOX BELOW THAT APPLIES (CHECK ONLY ONE):
_____________________________________________________________________________ APPLICANT’S SIGNATURE (IF NOT LANDOWNER OR LESSEE) DATE SIGNED
APPLICANT Resident Gratis Nonresident Landowner (Nonresident landowner applicant must submit $277.00 fee. Please see information on back of application).
As an applicant I certify that I am eligible for a resident gratis or nonresident landowner license. Applicant must sign below ONLY if they are not the landowner or lessee. Regardless of who uses the license, the landowner or lessee must sign to the right.
n I transfer my eligibility for a resident gratis or nonresident landowner license to my spouse.
n I transfer my eligibility to a legal dependent who resides with me.
I understand that by doing this I am not eligible to receive a resident gratis or nonresident landowner license.
PHONE RESIDENTS AGE 18 or OLDER - N.D. DRIVER’S LIC# or N.D. NONDRIVER PHOTO ID# (Required)
By Signing As LANDOWNER OR LESSEE, I CERTIFY THAT: (Persons making false statements on this form may be subject to prosecution.)
• I will be at least 14 years of age on or before December 31 of this year.• The land described above totals 150 acres or more.• If applying for a resident gratis license, I have actually lived in the state of North Dakota or maintained my residence
therein for the past six months (residency waivers are not eligible).• All the above described land is eligible for a resident gratis or nonresident landowner license (leased ND School Trust Land
is eligible, other leased State or Federal Government Land is not eligible).• I am submitting one and only one resident gratis or nonresident landowner license application for the land described above.• I understand that I can receive or transfer only one resident gratis or nonresident landowner license.
Total AcreageApplied For:
INFORMATION IN THIS SECTION SHOULD BE COMPLETED BY LANDOWNER OR LESSEENO LESS THAN 150 ACRES OF LAND MUST BE OWNED, OR LEASED FOR AGRICULTURAL PURPOSES
AND ACTIVELY FARMED OR RANCHED, TO BE ELIGIBLE FOR RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE.LEGAL LAND DESCRIPTION. PLEASE LIST BELOW. (Note: For additional land descriptions - attach separate sheet.)
I own all the land described as follows (Must provide full legal description if ownership is less than a full section.):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
or I lease, for agricultural purposes and actively farm or ranch all the described land from the following private party(ies) who is(are) not applying for the resident gratis or nonresident landowner license. You must list owner(s) of leased land on the following lines or application will be returned to you! Proof of lease to be supplied on request.
Legal leased land is described as follows (Must provide full legal description if ownership is less than a full section.):
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Section Township Range County
Section Township Range County
Section Township Range County
Section Township Range County
Section Township Range County
Owner of Leased Land
Owner of Leased Land
Legal Land Description
Legal Land Description
Legal Land Description
Legal Land Description
Legal Land Description
❑Personal ❑ LLC, LLP, Trust, Life Estate
❑Personal ❑ LLC, LLP, Trust, Life Estate
❑Personal ❑ LLC, LLP, Trust, Life Estate
Form of Ownership
Form of Ownership
Form of Ownership
DEADLINEApplications received
after June 1, 2016 will result in licenses
being issued from those remaining after the lottery.
PRINTED NAME OF LANDOWNER OR LESSEE DATE OF BIRTH
SIGNATURE OF LANDOWNER OR LESSEE
DATE SIGNED
LOGAN
GRANT
MORTON
BURLEIGH
STEELE
NELSON
WARD
ROLETTE
BOTTINEAU
4F
4C
4A2K1
1804
1804
1806
1806
1804
200A
1804
1806
1804
1804
1804
1806
1806
29
29
94
94
94
94
29
29
94
18
5
31
48
42
60
200
4
17
21
53
52
14
5
32
27
18
46
18
200
32
14
1
1
17
17
66
20
15
40
40
50
85
12
16
16
68
85
200
2
50
55
42
23
85
85
21
67
12
22
8
22
8
22
22
200200
22
73
22
50
8
5
28
28
37
37
8
8
8
49
21
31
49
49
31
200
28
83
256
83 4314
14
83
5241
53
41
48
8341
36
25
83
6
24
6
611
13
34
83
14 3
19
2
3
66
5
281
30281
19
2
57281
15
28130
200
36281
30
56
46
34
13
56
11
1
281
113
281 1
9
20
200
15
20
45
1
32
35 32
5
32
81
66
81
2
15
18
32
38
30
17
18
1
13
127
11
1832
11
20
32
20
18
52
3
13
9
26
13
17
2
30
24
52
32
15
2
8
23
83
200
3
3
46
13
65
18
66
23
40
8
Forman
Ellendale
Napoleon
FortYates
GrandForks
Minot
Rugby
Devils Lake
Grafton
Stanton
Dickinson
Mott
WatfordCity
Williston
Crosby
Lakota
Cando
Bottineau
Towner
Linton
Carson
Bowbells
Stanley
Washburn
Medora
Manning
BOWMAN
SLOPE
STARK
MOUNTRAIL
PEMBINA
MCHENRY
GRAND FORKS
BARNES
EMMONS
GOLDENVALLEY
SARGENT
RICHLAND
RANSOM
CAVALIER
OLIVER
MCKENZIE
Beach
Mandan
Cavalier
Langdon
Hillsboro
FessendenNew Rockford
Rolla
JamestownFargo
LaMoure
Lisbon
Bismarck
WILLIAMS
Wahpeton
Minnewaukan
BENSON
GRIGGS
Cooperstown
Finley
Steele
HETTINGER
BILLINGS
Amidon
RAMSEY
Carrington
FOSTER
52
MERCER
MCLEAN
3B2
12D
2L
2B2J2 2F22J13B33D2
3C
3F1
4E
3D1
2A
2G2
Valley City
Ashley
Mc Clusky
Center
Hettinger
Bowman
3A1 3A2
3A3
3F2
3A42E
2H
CASS
WALSH
ADAMS SIOUX DICKEY
WELLS
DIVIDE RENVILLETOWNER
KIDDER
4B
4D
2C
2G1
2K2
2G
MCINTOSH
BURKE
TRAILL
3B1
2I
DUNN
PIERCE
EDDY
LAMOURELittl
e
Littl
e M
isso
uri
R.
Missou
ri R.
STUTSMAN
SHERIDAN
3E1 3E2
2F1
2016 DEER GUN HUNTING UNITS
DEER BOW SEASON—September 2 (noon) through January 8, 2017. DEER GUN SEASON—November 4 (noon) through November 20, 2016.MUZZLELOADER SEASON—November 25 (noon) through December 11, 2016.
RESTRICTIONS ON THE RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE:• Licenses are available to residents and nonresidents owning, or residents leasing for agricultural purposes and actively farming
or ranching, at least 150 acres of land located in an open hunting unit (leased ND School Trust Land is eligible, other leased State or Federal Government Land is not eligible).
• The license is valid only upon land described on the application and subsequently the license.• The license is valid during the deer bow, deer gun, and muzzleloader seasons until filled.• The eligibility may be transferred to a spouse or legal dependent who has resided with the landowner for the previous six months.• If not otherwise specified in an agricultural lease, the landowner is entitled to receive the license.Please note that the resident gratis and nonresident landowner deer license mailout may be delayed due to background checks by enforcement.
A nonresident who holds title to at least 150 acres is eligible to apply for one percent (1%) of the permits available per unit. Nonresidents must submit $277.00 (includes $2.00 fee for fishing, hunting and furbearer certificate, $20.00 fee for nonresident general game and habitat license, and $5.00 nonrefundable application fee).
SOCIAL SECURITY NUMBER REQUIREMENT. In accordance with state law NDCC 20.1-03-35 and 42 US Code 666 (a) (13) and (16), the Department is required to collect social security numbers from all persons obtaining hunting, fishing, or other recreational type licenses. Your social security number serves as your principal identification number to determine license eligibility. It is kept confidential, however it may be provided to law enforcement agencies and the State Disbursement Unit to enforce child support obligations.
CORPORATIONS, COMPANIES, PARTNERSHIPS, TRUSTS AND LIFE ESTATES Only one license may be issued and the license must be issued in the name of an individual shareholder, member, partner, beneficiary, or holder of a life estate.
The NDGFD receives federal financial assistance from the US Fish and Wildlife Service. In accordance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and Title IX of the Education Amendments of 1972, the NDGFD joins the US Department of the Interior and its Bureaus in prohibiting discrimination on the basis of race, color, national origin, age, disability, sex (in education programs or activities) and also religion for the NDGFD. If you believe you have been discriminated against in any program, activity, or facility as described above, or you desire further information, please write to: ND Game and Fish Department, Attn: Chief Administrative Services, 100 N. Bismarck Expressway, Bismarck, ND 58501-5095 or to: US Fish and Wildlife Service, Attn: Civil Rights Coordinator, 4401 N. Fairfax Drive, Mail Stop: MBSP- 4020, Arlington, Virginia 22203. If you are disabled and desire application information for hunting and fishing opportunities in this state please contact the Department at 701-328-6300. The TTY/TTD (Relay ND) number for the hearing or speech impaired is 1-800-366-6888.
You can also apply for your resident gratis or nonresident landowner license via the internet — 24 hours a day — 7 days a week, making sure your application is in before the deadline. Visa, Discover and MasterCard accepted.
APPLYING BY COMPUTER . . . . QUICK – CONVENIENT – EASY visit our website at gf.nd.gov
Regular application feesapply with no service charge added.
( )
If any part of the application is incomplete or in error, the application will not be processed and will be returned to sender.
For 2016, no hunter may take antlerless mule deer in units
4A, 4B and 4C!
In accordance with state law (NDCC 20.1-02-05), a resident who is 18 years of age or older must submit a ND drivers license number or a ND nondriver photo ID number when applying for a license.
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