Form 3-2326 Federal Subsistence Hunt Application, Permit and Report

Federal Subsistence Hunt Application

OMB Control No. 1018-0075 Expires 06/30/2019

Wildlife - Registration

Permit No.

Federal Land Unit:

Unit(s) & Subunit(s):

AK Hunting License Number:

Applicant's Name (First, Middle Initial, Last):

Date of Birth (mm/dd/yy):

Telephone Number:

FEDERAL PERMIT
PERMIT NO:
Regulatory Year:

Mailing Address:

Physical Address:
HUNT NO: UNIT(S):
SEASON:
Community of Primary Residence:

Applicant's Signature

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

Issuing Agent (Print):
Date Permit Issued (mm/dd/yy):

LEGAL:
CONDITIONS: See Back

NON-TRANSFERABLE

Federal Subsistence Harvest Report Permit Number:
Permittee's Name:
Permit Event:
1. Did you hunt? Yes __

No __

Did you use a designated hunter where allowed? Yes __

No __

UNIT:
SEASON:
LEGAL:

2. A. How many days did you hunt? ____________
B. How did you get to hunt area? (Circle your primary method of getting to where you started walking)
1. Airplane
3. Boat
5. Snow machine
7. Highway Vehicle
2. Horse/Dog Sled
4. 3/4-Wheeler
6. Other off road vehicle
8. No vehicle used
C. Specific Locations______________________________

D. Subunit Hunted ___________________

E. Did you take an animal? Yes ___ No ___

Successful Harvest: Must
return permit Harvest Report
within 5 days day(s) after taking
an animal.
Unsuccessful or did not Hunt :
Must return permit Harvest
Report within 15 days after the
close of the season.

3. A. Date taken _______________ (mm/dd/yy)
B. Sex of animal: Male ____ Female ____

INTERNET REPORTING
http://fws.gov/alaska/harvestreport
UNIQUE CODE

Print Name :
___________________________
X____________________________________
Hunter's Signature

Not Avalible for this Permit
FWS Form 3-2326

Rev. 03/2017

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 Information Collection Clearance Officer, Division of Policy, Performance, and Management
Programs, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, Falls Church, VA 22041-3803.

U.S. Fish and Wildlife Service
Office of Subsistence Management, M/S 121
1011 E. Tudor Rd.
Anchorage, AK 99503-6199

Cut along the dotted line

Remove this Area
Before Mailing

Conditions of the Permit:

OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE $300

BUSINESS REPLY MAIL
FIRST CLASS MAIL PERMIT NO. 12874 ANCHORAGE, AK
POSTAGE WILL BE PAID BY US FISH AND WILDLIFE SERVICE

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US FISH AND WILDLIFE SERVICE c/o
USFS Cordova Ranger District
PO Box 280
Cordova, AK 99574-9985

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES