CERTIFIED DEER TRACKING DOG PERMIT APPLICATION
Permit Application Fee: $2.00
Name of Dog Handler:
Address:
City: State: Zip Code:
Email:
Day Phone: Home Phone:
Date of Birth: Social Security Number:
Conservation Identification Number (CID#):
Tracking Dog Information:
First Dog
Dog Name:
Breed: Date of Birth:
Physical Description (i.e. color, distinctive markings):
Microchip Number:
Certification Level (i.e. UBT-1): Date of Certification:
Certifying Organization:
A photograph of the dog must also be provided.
Second Dog
Dog Name:
Breed: Date of Birth:
Physical Description (i.e. color, distinctive markings):
Microchip Number:
Certification Level (i.e. UBT-1): Date of Certification:
Certifying Organization:
A photograph of the dog must also be provided.
I hereby certify that the above information is true and correct to the best of my knowledge and belief. I have
read and understand the regulations and policies of the Certified Deer Tracking Dog Permit. I acknowledge
that if the information provided is false, or if I fail to follow the regulations and policies of the permit, I am
subject to the fines and penalties allowed by law.
Signature of Applicant: Date:
Submit applications, fees (check or money order made payable to NJ Division of Fish and Wildlife), and
supporting documents to:
NJ Division of Fish and Wildlife, Mail Code 501-03, PO Box 420, Trenton, NJ 08625-0420.
For information visit www.njfishandwildlife.com/deer_trackingdog.htm.
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signature
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