Sportsmen Licenses Credit Redemption

LICENSE AND REVENUE OFFICE BUREAU OF FINANCIAL SERVICES DEPARTMENT OF ENVIRONMENTAL PROTECTION 79 ELM STREET HARTFORD, CT 06106-5127

Sportsmen Licenses Credit Redemption for Licenses/Permits Purchased between October 1, 2009 and April 14, 2010

Town Clerks and Agents cannot process purchase of licenses/permits when redeeming a credit. You must use this form to purchase by mail or purchase in person at the DEP facilities listed at www.ct.gov/dep/sportsmensfeereduction

Instructions: 1) Obtain the amount of your credit: a. Online at www.ct.gov/dep/sportsmenscredit Search using your Conservation ID# or b. Contact one of the following offices by phone: DEP License and Revenue Office 860-424-3105 Franklin Wildlife 860-642-7239 Sessions Woods 860-675-8130 Marine Headquarters 860-434-8638 Eastern District 860-295-9523 Western District 860-485-0226 2) Enter the credit amount in Part II, Item 3 of the form. 3) Complete Part 1 – Applicant Information, Part II – Items to Purchase and Part III - Signature 4) Mail the completed form and total amount due from Part II, #4 (check or money order payable to Department of Environmental Protection) to: License and Revenue Office Department of Environmental Protection 79 Elm Street Hartford, CT 06106-5127

You should retain a copy of the completed application for your records.

5) Please allow 10 days for processing. After 10 days, your 2011 license/permit will be available for you to print on-line at https://ct.outdoorcentral.net/InternetSales/ You must log in using your Conservation ID, bring up your profile and select “reprint license”. You can also go to a participating Town Clerk or Agent to have them print your license for you. NOTE: Participating Town Clerks and Agents cannot process purchase of licenses/permits when redeeming a credit. You must use this form to purchase by mail or purchase in person at the DEP facilities listed at www.ct.gov/dep/sportsmensfeereduction

DEP-FS-APP-002 1 of 4 Rev. 11/29/10 LICENSE AND REVENUE OFFICE BUREAU OF FINANCIAL SERVICES DEPARTMENT OF ENVIRONMENTAL PROTECTION 79 ELM STREET HARTFORD, CT 06106-5127

Sportsmen Licenses Credit Redemption for Licenses Purchased between October 1, 2009 and April 14, 2010

Part I: Applicant Information

1. Full Name: ______Mailing Address: City/Town: State: Zip Code: Daytime Phone: ext. Email: Date of Birth: Conservation ID #:

Part II: License and Permits to Purchase

DEP-FS-APP-002 2 of 4 Rev. 11/29/10 1. Select the items to purchase by placing an X in the first column and entering the fee under Purchase Amount:

Purchase Purchase License Fee Amount Resident Inland Waters Sport Fishing License $28.00 $ Resident Marine Waters Sport Fishing License $10.00 $ One Day Resident Marine Waters Sport Fishing License $5.00 $ Resident All Waters Sport Fishing License $32.00 $ Resident Combination Inland Waters Fishing and Firearms Hunting $38.00 $ License Resident Combination Marine Waters Sport Fishing and Firearms $25.00 $ Hunting License Resident Combination All Waters Sport Fishing and Firearms Hunting $38.00 $ License Resident Combination All Waters Sport Fishing License and Bow and $65.00 $ Arrow Permit to Hunt Deer and Small Game Resident Firearms Hunting License $19.00 $ Resident Archery Super Sport License to Fish in All Waters, Bow and Arrow Permit to Hunt Deer and Small Game, Permit to Hunt Wild $82.00 $ Turkey During Spring Season on Private Land Resident Firearms Super Sport License to Fish in All Waters and Firearms Hunt, Firearms Private Land Shotgun or Rifle Deer Permit, $84.00 $ Muzzleloader Private Land Deer Permit, and Permit to Hunt Wild Turkey During Spring Season on Private Land Fall Turkey Permits – Archery State or Private Land $19.00 $

Fall Turkey Permits – Firearms Private Land $19.00 $ Fall Turkey Permits – Firearms State Land $19.00 $ Spring Turkey Permits – Private Land $19.00 $ Spring Turkey Permits - State Land $19.00 $ Revolver Permit $5.00 $ Migratory Bird Conservation Stamp (Duck Stamp) $13.00 $ Pheasant Tags (10 tags) $28.00 $ Deer Hunting Firearms Permits - State Land No Lottery A $19.00 $ Deer Hunting Firearms Permits - State Land No Lottery B $19.00 $ Deer Hunting Firearms Permits - State Land Muzzleloader $19.00 $ Deer Hunting Firearms Permits - Private Land Shotgun/Rifle $19.00 $ Deer Hunting Firearms Permits - Private Land Muzzleloader $19.00 $ Archery Permit to Hunt Deer and Small Game $41.00 $ Resident Trapping License $34.00 $ Junior Trapping License $11.00 $ Junior Firearms Hunting License $11.00 $ Junior Archery Permit to Hunt Deer and Small Game $19.00 $ Nonresident Inland Waters Fishing License $55.00 $ Nonresident Inland Waters Fishing License For 3 Consecutive Days $22.00 $ Nonresident Marine Waters Fishing License $15.00 $ Nonresident Marine Waters Fishing License for 3 Consecutive Days $8.00 $ Nonresident All Waters Fishing License $63.00 $ Nonresident Combination License to Fish in Inland Waters and $110.00 $ Firearms Hunt Nonresident Combination License to Fish in Marine Waters and DEP-FS-APP-002 3 of 4 Rev. 11/29/10 2. Total Amount of Purchase (amount calculated in line above) $

3. Credit Amount (See instructions for information on how to obtain credit amount.) – $

4. Total Amount Due (amount in #2 minus amount in #3) $

Please make checks payable to: Department of Environmental Protection

Part III - Signature

Signature Date

Printed Name

DEP-FS-APP-002 4 of 4 Rev. 11/29/10