NAME TELEPHONE NUMBER (Home) TELEPHONE NUMBER (Business) (DRD), (Park Manager) ( 631 ) ( 631. Islip
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1 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF FISH, WILDLIFE AND MARINE RESOURCES COMPLAINT RECORD AND PERMIT FORM Permit to take destructive wildlife pursuant to Environmental Conservation Law REGIONAL WILDLIFE OFFICE Wildlife, 50 Circle SUNY S.B., Stony Brook, NY FAX: REG. YEAR REC. NUMBER CHECK IF DATA ENTERED NAME TELEPHONE NUMBER (Home) TELEPHONE NUMBER (Business) (DRD), (Park Manager) ( 631 ) ( 631 STREET ADDRESS ORGANIZATION (if applicable) P. O. Box 247 NYS Office of Parks, Recreation & Historic Preservation CITY/STATE/ZIP CODE ENVIRONMENTAL CONSERVATION OFFICER: Dustin Oliver Babylon, NY Central Dispatch (877) Location of Problem: Wildlife Management Unit 1C County Suffok Town Islip Location of Damage: Connetquot River State Park, Oakdale, NY.. DATE RECEIVED DATE HANDLED/ISSUED DATE EXPIRES Month: 12 Day: 30 Year: 11 Month: 01 Day: 03 Year: 12 Month: 12 Day: 31 Year: 12 Permit to take DEER: Repeat Complaint Permit with Standard Conditions You and your agents must comply with all standard conditions of this permit listed on this or additional pages. Permit with Special Conditions You and your agents must comply with all special conditions of this permit listed on this or additional pages. Killing of deer may only be accomplished by use of those weapons checked: Bow with legal hunting broadhead Shotgun with rifled slug Muzzleloader Type of problem, check all that apply Corn Grain Orchard Vineyard Nursery Natural Communities Community Garden Ornamental Beans Forage Airport Truck Farm Christmas Trees Forest Regeneration Home Garden Sod Farm Number of Tags Issued/Tag Numbers 8 ( ) Antlerless Only, 2 ( ) Either Sex, 15 ( ) Antlerless Only Special Conditions Approved Shooter/Vehicle List (Including license plate number): Actions Taken: Total time spent Handled by Other Actions: Added shooters - 11/30/12 - JCS
2 Standard Conditions for Nuisance Deer Permit (NYS - DEC - Region 1) 1. This permit is only valid after the permittee reads the Standard Conditions and signs the Agreement to Conditions below and returns the signed copy to the Regional Wildlife Office at the address or fax number listed on the front of the permit. 2. All agents on the approved shooter list must read the Standard Conditions and sign the Agreement to Conditions below and carry the signed permit with them at all times, along with an unfilled nuisance permit carcass tag, while in the field under this permit. 3. No person other than the permittee and approved shooters may accompany a shooter during the exercising of a permit. 4. No person may possess a loaded firearm in a vehicle. 5. Discharging a firearm from a vehicle is prohibited. 6. Shooters can only operate under a permit that bares their name as an approved agent of the permittee. 7. Agents must submit a valid New York State hunting license backtag number to the Wildlife Office to be listed on the permit. The agents hunting license does not need to be submitted annually. 8. Persons who have had their hunting privileges revoked or suspended may not act as an Agent on this permit. 9. All antlers taken under this permit must be turned in to the DEC (either the Stony Brook office or the Ridge Hunter Check Station) within seven days after taking unless other arrangements are made. DEC officials must be contacted within seven days if antlers will not be delivered on time. 10. Permit is only valid for property stated on the permit and is limited to those areas indicated by the permittee on the maps provided to the DEC with the permit application. Permittee and approved shooters are not authorized to trespass. 11. Central Dispatch ( ) and local police departments must be notified within 24 hours before and after going afield under the permit. The DEC Wildlife Office (631) must be called within 24 hours after returning from the field to report all animals harvested. 12. All deer taken must be prepared for consumption or buried within three days of taking. 13. In executing this permit, the permittee and approved shooters must obey all Federal, State, and local laws and ordinances governing such actions and obtain any additional permits as required. 14. If the permittee is leasing the property, written permission from the property owner must be obtained to conduct permit activity. 15. The permittee must obtain written permission from neighboring property owner to discharge a firearm within 500 feet from said neighbors building. Without written permission, permittee and/or approved shooters must stand at least 500 feet from neighboring property owners building 16. The permittee must return to the Department the Permit Summary Report and all unused carcass tags within 7 days of the expiration of this permit. It is ultimately the responsibility of the permittee to ensure the summary report is completed and submitted in a timely fashion. 17. The permit may be revoked or shooters removed by the Department at any time. 18. Use of a night vision scope is forbidden under this permit. ENVIRONMENTAL CONSERVATION LAW Possession of a loaded firearm in or on a motor vehicle is prohibited. Shooting from a motor vehicle or across any part of a public highway is prohibited. Shooting within 500 feet of a school, playground or an occupied factory or church is prohibited Shooting within 500 feet of a dwelling, farm building, or occupied structure is prohibited unless the shooter owns or leases the building or has the owner s consent. No person shall use a rifle on Long Island TAGGING, PROCESSING AND REPORTING THE DEER All deer taken must be tagged immediately. Every effort should be made to use the deer for human consumption. AGREEMENT TO CONDITIONS The Permittee and every Agent shooting on this Nuisance Deer Permit must read and abide by all of the Permit Conditions. In addition, each Agent must read the certification below and print their full name, address, date of birth, and sign their full name prior to exercising the privileges of this permit. By signing this form I agree that I have read, fully understand, and agree to abide by, and be responsible for, all of the attached Permit Conditions. Print Full Name Address Permit Name Permit # Signature I have read and understand the permit conditions and the above heading and affirm under penalty of perjury that all information is true pursuant to section Penal Law
3 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DIVISION OF FISH, WILDLIFE AND MARINE RESOURCES COMPLAINT RECORD AND PERMIT FORM Permit to take destructive wildlife pursuant to Environmental Conservation Law REGIONAL WILDLIFE OFFICE Wildlife, 50 Circle SUNY S.B., Stony Brook, NY FAX: REG. YEAR REC. NUMBER CHECK IF DATA ENTERED NAME TELEPHONE NUMBER (Home) TELEPHONE NUMBER (Business) (DRD), (Park Manager) ( 631 ) ( 631 STREET ADDRESS ORGANIZATION (if applicable) P. O. Box 247 NYS Office of Parks, Recreation & Historic Preservation CITY/STATE/ZIP CODE ENVIRONMENTAL CONSERVATION OFFICER: Dustin Oliver Babylon, NY Central Dispatch (877) Location of Problem: Wildlife Management Unit 1C County Suffok Town Islip Location of Damage: Connetquot River State Park, Oakdale, NY.. DATE RECEIVED DATE HANDLED/ISSUED DATE EXPIRES Month: 12 Day: 28 Year: 12 Month: 01 Day: 01 Year: 13 Month: 03 Day: 31 Year: 13 Permit to take DEER: Repeat Complaint Permit with Standard Conditions You and your agents must comply with all standard conditions of this permit listed on this or additional pages. Permit with Special Conditions You and your agents must comply with all special conditions of this permit listed on this or additional pages. Killing of deer may only be accomplished by use of those weapons checked: Bow with legal hunting broadhead Shotgun with rifled slug Muzzleloader Type of problem, check all that apply Corn Grain Orchard Vineyard Nursery Natural Communities Community Garden Ornamental Beans Forage Airport Truck Farm Christmas Trees Forest Regeneration Home Garden Sod Farm Number of Tags Issued/Tag Numbers 25 Antlerless Only ( ) Special Conditions Approved Shooter/Vehicle List (Including license plate number): Actions Taken: Total time spent Handled by Josh Stiller Other Actions: Added 5 shooters - JCS - 3/11/13
4 Standard Conditions for Nuisance Deer Permit (NYS - DEC - Region 1) 1. This permit is only valid after the permittee reads the Standard Conditions and signs the Agreement to Conditions below and returns the signed copy to the Regional Wildlife Office at the address or fax number listed on the front of the permit. 2. All agents on the approved shooter list must read the Standard Conditions and sign the Agreement to Conditions below and carry the signed permit with them at all times, along with an unfilled nuisance permit carcass tag, while in the field under this permit. 3. No person other than the permittee and approved shooters may accompany a shooter during the exercising of a permit. 4. No person may possess a loaded firearm in a vehicle. 5. Discharging a firearm from a vehicle is prohibited. 6. Shooters can only operate under a permit that bares their name as an approved agent of the permittee. 7. Agents must submit a valid New York State hunting license backtag number to the Wildlife Office to be listed on the permit. The agents hunting license does not need to be submitted annually. 8. Persons who have had their hunting privileges revoked or suspended may not act as an Agent on this permit. 9. All antlers taken under this permit must be turned in to the DEC (either the Stony Brook office or the Ridge Hunter Check Station) within seven days after taking unless other arrangements are made. DEC officials must be contacted within seven days if antlers will not be delivered on time. 10. Permit is only valid for property stated on the permit and is limited to those areas indicated by the permittee on the maps provided to the DEC with the permit application. Permittee and approved shooters are not authorized to trespass. 11. Central Dispatch ( ) and local police departments must be notified within 24 hours before and after going afield under the permit. The DEC Wildlife Office (631) must be called within 24 hours after returning from the field to report all animals harvested. 12. All deer taken must be prepared for consumption or buried within three days of taking. 13. In executing this permit, the permittee and approved shooters must obey all Federal, State, and local laws and ordinances governing such actions and obtain any additional permits as required. 14. If the permittee is leasing the property, written permission from the property owner must be obtained to conduct permit activity. 15. The permittee must obtain written permission from neighboring property owner to discharge a firearm within 500 feet from said neighbors building. Without written permission, permittee and/or approved shooters must stand at least 500 feet from neighboring property owners building 16. The permittee must return to the Department the Permit Summary Report and all unused carcass tags within 7 days of the expiration of this permit. It is ultimately the responsibility of the permittee to ensure the summary report is completed and submitted in a timely fashion. 17. The permit may be revoked or shooters removed by the Department at any time. 18. Use of a night vision scope is forbidden under this permit. ENVIRONMENTAL CONSERVATION LAW Possession of a loaded firearm in or on a motor vehicle is prohibited. Shooting from a motor vehicle or across any part of a public highway is prohibited. Shooting within 500 feet of a school, playground or an occupied factory or church is prohibited Shooting within 500 feet of a dwelling, farm building, or occupied structure is prohibited unless the shooter owns or leases the building or has the owner s consent. No person shall use a rifle on Long Island TAGGING, PROCESSING AND REPORTING THE DEER All deer taken must be tagged immediately. Every effort should be made to use the deer for human consumption. AGREEMENT TO CONDITIONS The Permittee and every Agent shooting on this Nuisance Deer Permit must read and abide by all of the Permit Conditions. In addition, each Agent must read the certification below and print their full name, address, date of birth, and sign their full name prior to exercising the privileges of this permit. By signing this form I agree that I have read, fully understand, and agree to abide by, and be responsible for, all of the attached Permit Conditions. Print Full Name Address Permit Name Permit # Signature I have read and understand the permit conditions and the above heading and affirm under penalty of perjury that all information is true pursuant to section Penal Law
5 R New York State Department of Environmental Conservation Division of Fish, Wildlife and Marine Resources Region 1 Headquarters 50 Circle Rd. Stony Brook, NY PERMIT TO TAKE OR HARASS NUISANCE OR DESTRUCTIVE WILDLIFE PERMIT: Region Joseph Martens Commissioner Date issued: 2/27/2014 Permit expires: 9/30/2014 PERMITTEE: LOCATION OF PROBLEM: County: Suffolk NYSOPRHP (Connetquot) Town(s): Islip Crops effected: Community Garden, Forage, Public Health and P. O. Box 247 Safety Babylon, NY Location of Damage: Connetquot State Park Home Phone: Work Phone: Pursuant to ECL sections and , you or your Agent may: Take 100 antlerless white-tailed deer (carcass tags ) and 0 either sex deer (carcass tags NA) Shoot deer using Firearms with a single projectile Special Conditions (conditions in this section are in addition to the Standard Permit conditions): 1) Deer carcasses must be utilized for human consumption. 2) Baiting may only occur between January 1 and April 30th and under the following conditions: a. Bait must not contain any supplemental protein b. The type of bait is limited to whole corn, cracked corn or unprocessed fruit and vegetable matter. c. No more than 10 pounds of bait per day shall be placed on the subject parcel d. All bait shall be placed greater than 300 feet from the road e. All baiting shall cease on the last day of shooting on the subject parcel 3) A shooter list of USDA marksmen must be submitted to the department prior to acting pursuant to this permit. Only shooters listed on the approved marksmen list may act pursuant to this permit. 4) A summary of the age, sex, and reproductive status must be reported to the department upon completion of activities pursuant to this permit. STANDARD PERMIT CONDITIONS: GENERAL 1. This permit is not valid unless or until the AGREEMENT TO CONDITIONS is signed by the permittee and agent. The signed permit must be carried afield by any person acting pursuant to this permit. 2. Only the permittee and agents may be afield when acting pursuant to this permit. 3. Permittee must maintain a complete log of approved USDA agents (log sheet provided), available to department staff or law enforcement immediately upon request. 4. Agents must possess a valid New York State hunting license, hunter education certificate, or certificate of safe firearms training. 5. Agents must be at least 18 years of age. 6. Persons who have had their hunting privileges revoked or suspended may not act as an agent on this permit. 7. Persons who have previously been found in violation of Deer Damage Permits issued pursuant to ECL sections and may not act as an agent unless they receive express written consent from the New York State Department of Environmental Conservation. 8. This permit is valid only on lands owned, rented or leased by the permittee. 9. Permittee must first obtain permission from the landowner before using this permit on leased or rented lands.
6 10. The Department has the right to inspect any building, structure or property used for any activity pursuant to this permit. 11. The permittee is responsible for any property damage caused by the agents while using the permit. 12. The use of artificial lights is permitted when shooting after sunset. REPORTING 13. Central Dispatch ( ) and local police departments must be notified by the agent or permittee within 24 hours before and after going afield pursuant to this permit. 14. All harvested deer must be recorded on the provided Deer Damage Permit Summary Report within 24 hours of harvest. The log must be available to department staff upon request. 15. The permittee must return to the Department the shooter log, Permit summary, and Renewal Report within 10 days of the permit s expiration date. It is the responsibility of the permittee to ensure the Permit Summary and Renewal Report is completed and submitted on time. TAGGING 16. All deer must be tagged with a valid deer damage carcass tag. Tags must be filled out immediately upon harvest and attached to the carcass prior to being transported. PROCESSING 17. If permit conditions allow for the taking of antlered deer, all antlers from legally antlered deer (>3 on one side) must be surrendered to the Department within 7 days. It is the permittee s responsibility to make ensure the antlers have been surrendered to the local Environmental Conservation officer or NYSDEC wildlife staff. 18. All deer taken must be prepared for consumption or buried within three days of taking. Every effort should be made to use the deer for human consumption. AGREEMENT TO CONDITIONS I have read and fully understand the above permit conditions and agree to abide by them. Further, I am aware that failure to comply with any conditions of this permit may result in its revocation, denial of future permits, and violations and/or fines. Permittee signature: Date: Permit: Region
7 R New York State Department of Environmental Conservation Division of Fish, Wildlife and Marine Resources Region 1 Headquarters 50 Circle Rd. Stony Brook, NY PERMIT TO TAKE OR HARASS NUISANCE OR DESTRUCTIVE WILDLIFE PERMIT: Region Joseph Martens Commissioner Date issued: 12/31/2014 Permit expires: 9/30/2015 PERMITTEE: LOCATION OF PROBLEM: County: Suffolk NYSOPRHP (Connetquot) Town(s): Islip P. O. Box 247 Crops effected: Community Garden, Forage, Public Health and Safety Babylon, NY Location of Damage: Connetquot State Park Home Phone: Work Phone: Pursuant to ECL sections and , you or your Agent may: Take 100 antlerless white-tailed deer (carcass tags ) and 0 either sex deer (carcass tags NA) Shoot deer using Firearms with a single projectile Special Conditions (conditions in this section are in addition to the Standard Permit conditions): 1) Deer carcasses must be utilized for human consumption. 2) Baiting may only occur between January 1 and April 30th and under the following conditions: a. Bait must not contain any supplemental protein b. The type of bait is limited to whole corn, cracked corn or unprocessed fruit and vegetable matter. c. No more than 20 pounds of bait per day shall be placed on the subject parcel d. All bait shall be placed greater than 300 feet from the road e. All baiting shall cease on the last day of shooting on the subject parcel 3) Only USDA employed marksmen may act pursuant to this permit. 4) A summary of the age, sex, and reproductive status (for all females harvested after Feb. 1st) must be reported to the department upon completion of activities pursuant to this permit. STANDARD PERMIT CONDITIONS: GENERAL 1. This permit is not valid unless or until the AGREEMENT TO CONDITIONS is signed by the permittee and agent. The signed permit must be carried afield by any person acting pursuant to this permit. 2. Only the permittee and agents may be afield when acting pursuant to this permit. 3. Agents must possess a valid New York State hunting license, hunter education certificate, or certificate of safe firearms training. 4. Agents must be at least 18 years of age. 5. Persons who have had their hunting privileges revoked or suspended may not act as an agent on this permit. 6. Persons who have previously been found in violation of Deer Damage Permits issued pursuant to ECL sections and may not act as an agent unless they receive express written consent from the New York State Department of Environmental Conservation. 7. This permit is valid only on lands owned, rented or leased by the permittee. 8. Permittee must first obtain permission from the landowner before using this permit on leased or rented lands. 9. The Department has the right to inspect any building, structure or property used for any activity pursuant to this permit. 10. The permittee is responsible for any property damage caused by the agents while using the permit. 11. The use of artificial lights is permitted when shooting after sunset.
8 REPORTING 13. Central Dispatch ( ) and local police departments must be notified by the agent or permittee within 24 hours before and after going afield pursuant to this permit. 14. All harvested deer must be recorded on the provided Deer Damage Permit Summary Report within 24 hours of harvest. The log must be available to department staff upon request. 15. The permittee must return to the Department the shooter log, Permit summary, and Renewal Report within 10 days of the permit s expiration date. It is the responsibility of the permittee to ensure the Permit Summary and Renewal Report is completed and submitted on time. TAGGING 16. All deer must be tagged with a valid deer damage carcass tag. Tags must be filled out immediately upon harvest and attached to the carcass prior to being transported. PROCESSING 17. If permit conditions allow for the taking of antlered deer, all antlers from legally antlered deer (>3 on one side) must be surrendered to the Department within 7 days. It is the permittee s responsibility to make ensure the antlers have been surrendered to the local Environmental Conservation officer or NYSDEC wildlife staff. 18. All deer taken must be prepared for consumption or buried within three days of taking. Every effort should be made to use the deer for human consumption. AGREEMENT TO CONDITIONS I have read and fully understand the above permit conditions and agree to abide by them. Further, I am aware that failure to comply with any conditions of this permit may result in its revocation, denial of future permits, and violations and/or fines. Permittee signature: Date: Permit: Region
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