Form 3-2327 Federal Subsistence Designated Hunter Application Hunt R

OMB Control No. 1018-0075 Expires: XX/XX/XXXX

DESIGNATED HUNTER
FEDERAL PERMIT

Federal Land Unit

Mailing Address

Physical Address

City, State, Zip Code

Community of Primary Residence
Telephone Number

AK Hunting License No.

Date Permit Issued (mm/dd/yy)

Applicant's Signature (for minors, parent/legal guardian)

Issuing Agent (Print)

X
regulations as found in 50 CFR 100 and 36 CFR 242.

Federal Subsistence
Harvest Report
DESIGNATED HUNTER

Permit No.

Permittee (Name) ________________________________ Community: _________________________________
Check box if you did not hunt as a Designated Hunter

List All Other Persons for Whom You Hunted:

Name

Harvest
AK Hunting Ticket/
License # Permit #

Subunit/
Unit

Drainage or Specific Location

Number of Animals
Harvested
Male Female

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

_______________________________________

_______________ ______________ __________ _____________________________________________________________ ______ ______

List All Other Persons for Whom You Hunted:

I certify that I am a rural resident as defined by 50 CFR 100.4 and 36 CFR 242.4. I have read
and understand the conditions on the permit and agree to comply with them and applicable

Hunting
License #

Date of Birth

Name

Applicant’s Name (First, Middle Initial, Last)

UNIT:
PERMIT NO:
SPECIES:

Number of

Unit(s) & Subunit(s)

Permit No.

Animals Harvested
Harvest Ticket/ Unit/
Drainage or
Permit #
Subunit Specific Location Male Female

Federal Subsistence Designated Hunter Application

Print NAME:

X
PLEASE MAIL  Thank You for Your Cooperation.

HUNTER'S SIGNATURE
FWS Form 3-2327 REV 10/09

Additional Conditions of the Permit:
Additional Conditions of the Permit:

In accordance with the Privacy Act (5 U.S.C. 552a) and the Paperwork Reduction Act (44 U.S.C. 3501), please note the following information. This information collection is authorized by the Alaska National Interest Lands Conservation Act and associated regulations. The Federal Subsistence Board will use this information to manage fish and wildlife resources for subsistence uses. It is our policy not to use your name for
any other purpose. We will maintain this information in accordance with the Privacy Act. Your response is voluntary, but is required to obtain or retain a benefit. We may not conduct or sponsor and you are not
required to respond to an information collection unless it displays a currently valid OMB control number. OMB has approved this information collection and assigned OMB Control No. 1018-0075. We estimate
it will take you about 15 minutes to complete the application and record your harvest. This burden estimate includes time for reviewing instructions, gathering data, and completing and reviewing the form.
You may direct comments regarding the burden estimate or any other aspect of the form to the Service Information Collection Clearance Officer, Fish and Wildlife Service, Mail Stop 2042-PDM, Arlington Square,
Department of the Interior, 1849 C Street, NW., Washington D.C. 20240.

Return Address

Wildlife needs your
cooperation

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

BUSINESS REPLY MAIL

FIRST CLASS MAIL

PERMIT NO. 12874

ANCHORAGE AK

POSTAGE WILL BE PAID BY ADDRESSEE

Good management helps ensure that
animals will be available to hunt in future
years.
Harvest information is a tool that can be
used to help understand and maintain
healthy wildlife populations, thereby
providing for continued subsistence opportunity.

Address

Post Office Bar Code