Fill - Free fillable License Restoration Petition Form PDF form

NJDepartmentofEnvironmentalProtection

DivisionofFishandWildlife



EarlyLicenseRestorationOrderPetitionForm

ThisformistobeusedbythosepetitioningtheNJFishandGameCouncilfor

restorationoffishingand/orhuntingprivilegeswhicharecurrentlyrevoked.Notethat

apersonisineligibletopetitiontheCouncilforearlylicenserestorationifheorshehas

beenconvictedofthefollowing:

‐ anyviolationofN.J.S.A.23:7‐3

‐ anyviolationofN.J.S.A.23:9A‐2

‐ twoviolationsofthesamestatuteatN.J.S.A.23:4‐16(d),N.J.S.A.23:7‐1,and

N.J.S.A.23:7‐9.



Theformcanbeprintedandcompletedbyhand,orcompletedonline(exceptfor

signatures)andprinted.Completedformsshouldbemailedtotheaddressattheend

oftheform.



PETITIONTOTHEFISHANDGAMECOUNCILFORANEARLYLICENSE

RESTORATIONORDER

SectionI.PetitionerInformation(Pleaseprintlegibly)

NameofPetitioner:



Address:



TelephoneNumber:



Dateofbirth:



AttorneyName(ifapplicable):



Address:



TelephoneNumber:



Violation1

listedonNotice

ofRevocation

Letter



N.J.S.A./N.J.A.C.________________________________



DateofConviction:______________________________



Violation2

listedonNotice

ofRevocation

Letter



N.J.S.A./N.J.A.C.________________________________



DateofConviction:_______________________________



SectionII.PetitionOverviewChecklist

Pleaseusethischecklisttoensurethatyourpetitioniscomplete.Thelasttwoitemson

thelistareoptionalandareopportunitiestoattachsupplementaryevidenceorspeakto

theCouncilinpersonatthepublicmeetinginadditiontotheinformationprovidedin

thispetition.



TheCouncilwillnotscheduleyourpetitionfordiscussionatapublicmeetinguntil

thispetitioniscomplete.



Ihaveattachedacopyofthenoticeoflicenserevocationletterwhichinformed

meoftheopportunitytopetitionforearlyrestoration.



Ihaveprovidedreasonsinsupportofmypetitionbydescribingtheminornature

oftheviolation(s)and/orotherextenuatingcircumstances,andhavesignedto

attesttothetruthandaccuracyofmyreasons.(SectionIII.below)



IhavesignedPetitioner’sCertificationastoNoticeofPotentialPublicDisclosure.

(SectionIV.below)



Optional:Ihavechosentoattachsupplementaryevidencesupportingmy

petition.



Optional:Inadditiontothispaperpetition,IalsowishtospeaktotheCouncilin

personatthepublicmeeting.



SectionIII.StatementofReasonsinSupportofthePetitionforEarlyRestoration

Pleaseselecttheapplicablecircumstance(s)belowanddescribethereasonssupporting

yourpetitionindetail.Youmayattachadditionalsheetsifnecessary.Iampetitioning

theFishandGameCouncilforearlyrestorationofmylicense(s)because:

 theviolationswereminorinnatureAND/OR

therewereotherextenuatingcircumstances



Theviolationswereminorinnaturebecause/theextenuatingcircumstancesareasfollows:



Theabovestatementofreasonsandanyattachmentstheretoaretrueandaccurateto

thebestofmyknowledge.



_________________________________________________________________________

PetitionerSignature(SectionIII.)    Date

SectionIV.Petitioner’sCertificationastoNoticeofPotentialPublicDisclosure

Allpersonalidentifyinginformation(e.g.identity,name,address,socialsecurity

number,telephonenumber,faxnumber,driverʹslicensenumber,emailaddress)

receivedbytheDivisioninconnectionwiththeissuanceofanylicenseauthorizing

huntingwithafirearmisconfidentialpursuanttotheOpenPublicRecordsAct,N.J.S.A.

47:1A‐1etseq.,andthereforecannotbedisclosedwhensomeonemakesarequestfor

publicrecords.Pleasebeawarehoweverthatsuchinformationisnotprotectedfrom

publicdisclosureduringCouncilmeetingsundertheOpenPublicMeetingsAct,N.J.S.A.

10:4‐6etseq.orathearingsbeforetheOfficeofAdministrativeLaw.TheCouncilorthe

OfficeofAdministrativeLawmayneedtopubliclydiscussyouridentityandfirearm

license,ownership,and/orpossessionifsuchinformationispertinenttodecidingyour

petition.Pleasecertifybelowthatyouhavereceivednotificationofthepossibilityof

disclosureofsuchinformationatthepublicmeetingandhearingonyourpetition.



IcertifythatIunderstandthemeeting(s)orhearing(s)onmy

petitionforanearlylicenserestorationorderarepublic,and

thatmyidentityandthefactthatImighthaveorcurrently

possessafirearmcouldbedisclosedtothepublicduringthe

courseofsaidmeeting(s)/hearing(s)ifsuchinformationis

latedtotheviolation(s)and/orextenuatingcircumstances.

DespitethepossibilityofsuchpublicdisclosureIwishto

petitiontheCouncilforearlylicenserestoration.



________________________________________________________________________

PetitionerCertifyingSignature(SectionIV.)  Date

Pleasemailthiscompleted,fullysigned,anddatedPetitionforanEarlyLicense

RestorationOrderto:

NJFishandGameCouncil

Attn:LicenseRestorationPetitions

MailCode501‐03

POBox420

Trenton,NJ08625‐0420

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