2016 RESIDENT GRATIS AND NONRESIDENT LANDOWNER(preferential landowner) DEER LICENSE APPLICATIONNorth Dakota Game and Fish DepartmentLicensing Division, SFN 6108

PLEASE SEE RESTRICTIONS ON BACK OF APPLICATION. (If you need any assistance in filling out this application, contact the N.D. Game & Fish Department.)INFORMATION IN THIS SECTION SHOULD BE COMPLETED IN ITS ENTIRETY BY PERSON WHO WILL USE LICENSE.An individual having a RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE may also apply for a bow season license and a muzzleloader season license. An individual may use the RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE during the deer bow, deer gun, and muzzleloader seasons until license is filled.

Please provide us with your three line address. Press firmly and print legibly to avoid delays.

Birthdate _______ ______ ______ ______________________________________ ____________ ____________ (mo) (day) (yr) Social Security Number (required, see back of form) Sex Age

Mail this entire 2 part form to:Deer Lottery – NDGFD

100 N. Bismarck ExpresswayBismarck, ND 58501-5095

Phone (701) 328-6300

LAST NAME FIRST MIDDLE

ADDRESS

CITY STATE ZIP

UNIT(S) WHERE LAND IS LOCATED (see map)

TO TRANSFER ELIGIBILITY CHECK THE BOX BELOW THAT APPLIES (CHECK ONLY ONE):

_____________________________________________________________________________ APPLICANT’S SIGNATURE (IF NOT LANDOWNER OR LESSEE) DATE SIGNED

APPLICANT Resident Gratis Nonresident Landowner (Nonresident landowner applicant must submit $277.00 fee. Please see information on back of application).

As an applicant I certify that I am eligible for a resident gratis or nonresident landowner license. Applicant must sign below ONLY if they are not the landowner or lessee. Regardless of who uses the license, the landowner or lessee must sign to the right.

n I transfer my eligibility for a resident gratis or nonresident landowner license to my spouse.

n I transfer my eligibility to a legal dependent who resides with me.

I understand that by doing this I am not eligible to receive a resident gratis or nonresident landowner license.

PHONE RESIDENTS AGE 18 or OLDER - N.D. DRIVER’S LIC# or N.D. NONDRIVER PHOTO ID# (Required)

By Signing As LANDOWNER OR LESSEE, I CERTIFY THAT: (Persons making false statements on this form may be subject to prosecution.)

• I will be at least 14 years of age on or before December 31 of this year.• The land described above totals 150 acres or more.• If applying for a resident gratis license, I have actually lived in the state of North Dakota or maintained my residence

therein for the past six months (residency waivers are not eligible).• All the above described land is eligible for a resident gratis or nonresident landowner license (leased ND School Trust Land

is eligible, other leased State or Federal Government Land is not eligible).• I am submitting one and only one resident gratis or nonresident landowner license application for the land described above.• I understand that I can receive or transfer only one resident gratis or nonresident landowner license.

Total AcreageApplied For:

INFORMATION IN THIS SECTION SHOULD BE COMPLETED BY LANDOWNER OR LESSEENO LESS THAN 150 ACRES OF LAND MUST BE OWNED, OR LEASED FOR AGRICULTURAL PURPOSES

AND ACTIVELY FARMED OR RANCHED, TO BE ELIGIBLE FOR RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE.LEGAL LAND DESCRIPTION. PLEASE LIST BELOW. (Note: For additional land descriptions - attach separate sheet.)

I own all the land described as follows (Must provide full legal description if ownership is less than a full section.):

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

or I lease, for agricultural purposes and actively farm or ranch all the described land from the following private party(ies) who is(are) not applying for the resident gratis or nonresident landowner license. You must list owner(s) of leased land on the following lines or application will be returned to you! Proof of lease to be supplied on request.

Legal leased land is described as follows (Must provide full legal description if ownership is less than a full section.):

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

Section Township Range County

Section Township Range County

Section Township Range County

Section Township Range County

Section Township Range County

Owner of Leased Land

Owner of Leased Land

Legal Land Description

Legal Land Description

Legal Land Description

Legal Land Description

Legal Land Description

❑Personal ❑ LLC, LLP, Trust, Life Estate

❑Personal ❑ LLC, LLP, Trust, Life Estate

❑Personal ❑ LLC, LLP, Trust, Life Estate

Form of Ownership

Form of Ownership

Form of Ownership

DEADLINEApplications received

after June 1, 2016 will result in licenses

being issued from those remaining after the lottery.

PRINTED NAME OF LANDOWNER OR LESSEE DATE OF BIRTH

SIGNATURE OF LANDOWNER OR LESSEE

DATE SIGNED

LOGAN

GRANT

MORTON

BURLEIGH

STEELE

NELSON

WARD

ROLETTE

BOTTINEAU

4F

4C

4A2K1

1804

1804

1806

1806

1804

200A

1804

1806

1804

1804

1804

1806

1806

29

29

94

94

94

94

29

29

94

18

5

31

48

42

60

200

4

17

21

53

52

14

5

32

27

18

46

18

200

32

14

1

1

17

17

66

20

15

40

40

50

85

12

16

16

68

85

200

2

50

55

42

23

85

85

21

67

12

22

8

22

8

22

22

200200

22

73

22

50

8

5

28

28

37

37

8

8

8

49

21

31

49

49

31

200

28

83

256

83 4314

14

83

5241

53

41

48

8341

36

25

83

6

24

6

611

13

34

83

14 3

19

2

3

66

5

281

30281

19

2

57281

15

28130

200

36281

30

56

46

34

13

56

11

1

281

113

281 1

9

20

200

15

20

45

1

32

35 32

5

32

81

66

81

2

15

18

32

38

30

17

18

1

13

127

11

1832

11

20

32

20

18

52

3

13

9

26

13

17

2

30

24

52

32

15

2

8

23

83

200

3

3

46

13

65

18

66

23

40

8

Forman

Ellendale

Napoleon

FortYates

GrandForks

Minot

Rugby

Devils Lake

Grafton

Stanton

Dickinson

Mott

WatfordCity

Williston

Crosby

Lakota

Cando

Bottineau

Towner

Linton

Carson

Bowbells

Stanley

Washburn

Medora

Manning

BOWMAN

SLOPE

STARK

MOUNTRAIL

PEMBINA

MCHENRY

GRAND FORKS

BARNES

EMMONS

GOLDENVALLEY

SARGENT

RICHLAND

RANSOM

CAVALIER

OLIVER

MCKENZIE

Beach

Mandan

Cavalier

Langdon

Hillsboro

FessendenNew Rockford

Rolla

JamestownFargo

LaMoure

Lisbon

Bismarck

WILLIAMS

Wahpeton

Minnewaukan

BENSON

GRIGGS

Cooperstown

Finley

Steele

HETTINGER

BILLINGS

Amidon

RAMSEY

Carrington

FOSTER

52

MERCER

MCLEAN

3B2

12D

2L

2B2J2 2F22J13B33D2

3C

3F1

4E

3D1

2A

2G2

Valley City

Ashley

Mc Clusky

Center

Hettinger

Bowman

3A1 3A2

3A3

3F2

3A42E

2H

CASS

WALSH

ADAMS SIOUX DICKEY

WELLS

DIVIDE RENVILLETOWNER

KIDDER

4B

4D

2C

2G1

2K2

2G

MCINTOSH

BURKE

TRAILL

3B1

2I

DUNN

PIERCE

EDDY

LAMOURELittl

e

Littl

e M

isso

uri

R.

Missou

ri R.

STUTSMAN

SHERIDAN

3E1 3E2

2F1

2016 DEER GUN HUNTING UNITS

DEER BOW SEASON—September 2 (noon) through January 8, 2017. DEER GUN SEASON—November 4 (noon) through November 20, 2016.MUZZLELOADER SEASON—November 25 (noon) through December 11, 2016.

RESTRICTIONS ON THE RESIDENT GRATIS OR NONRESIDENT LANDOWNER LICENSE:• Licenses are available to residents and nonresidents owning, or residents leasing for agricultural purposes and actively farming

or ranching, at least 150 acres of land located in an open hunting unit (leased ND School Trust Land is eligible, other leased State or Federal Government Land is not eligible).

• The license is valid only upon land described on the application and subsequently the license.• The license is valid during the deer bow, deer gun, and muzzleloader seasons until filled.• The eligibility may be transferred to a spouse or legal dependent who has resided with the landowner for the previous six months.• If not otherwise specified in an agricultural lease, the landowner is entitled to receive the license.Please note that the resident gratis and nonresident landowner deer license mailout may be delayed due to background checks by enforcement.

A nonresident who holds title to at least 150 acres is eligible to apply for one percent (1%) of the permits available per unit. Nonresidents must submit $277.00 (includes $2.00 fee for fishing, hunting and furbearer certificate, $20.00 fee for nonresident general game and habitat license, and $5.00 nonrefundable application fee).

SOCIAL SECURITY NUMBER REQUIREMENT. In accordance with state law NDCC 20.1-03-35 and 42 US Code 666 (a) (13) and (16), the Department is required to collect social security numbers from all persons obtaining hunting, fishing, or other recreational type licenses. Your social security number serves as your principal identification number to determine license eligibility. It is kept confidential, however it may be provided to law enforcement agencies and the State Disbursement Unit to enforce child support obligations.

CORPORATIONS, COMPANIES, PARTNERSHIPS, TRUSTS AND LIFE ESTATES Only one license may be issued and the license must be issued in the name of an individual shareholder, member, partner, beneficiary, or holder of a life estate.

The NDGFD receives federal financial assistance from the US Fish and Wildlife Service. In accordance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and Title IX of the Education Amendments of 1972, the NDGFD joins the US Department of the Interior and its Bureaus in prohibiting discrimination on the basis of race, color, national origin, age, disability, sex (in education programs or activities) and also religion for the NDGFD. If you believe you have been discriminated against in any program, activity, or facility as described above, or you desire further information, please write to: ND Game and Fish Department, Attn: Chief Administrative Services, 100 N. Bismarck Expressway, Bismarck, ND 58501-5095 or to: US Fish and Wildlife Service, Attn: Civil Rights Coordinator, 4401 N. Fairfax Drive, Mail Stop: MBSP- 4020, Arlington, Virginia 22203. If you are disabled and desire application information for hunting and fishing opportunities in this state please contact the Department at 701-328-6300. The TTY/TTD (Relay ND) number for the hearing or speech impaired is 1-800-366-6888.

You can also apply for your resident gratis or nonresident landowner license via the internet — 24 hours a day — 7 days a week, making sure your application is in before the deadline. Visa, Discover and MasterCard accepted.

APPLYING BY COMPUTER . . . . QUICK – CONVENIENT – EASY visit our website at gf.nd.gov

Regular application feesapply with no service charge added.

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If any part of the application is incomplete or in error, the application will not be processed and will be returned to sender.

For 2016, no hunter may take antlerless mule deer in units

4A, 4B and 4C!

In accordance with state law (NDCC 20.1-02-05), a resident who is 18 years of age or older must submit a ND drivers license number or a ND nondriver photo ID number when applying for a license.