White-tailed Deer Enclosure Annual Facility Permit Application

Section 17 – Plan PreparationWhite-tailed Deer EnclosureAnnual Facility Permit Application(Page 6)Individual Preparing Plan: Landowner Manager Consulting Wildlife BiologistSection 18 – Landowner AffidavitBy my signature below, I certify that I am the landowner of the above described property. I also certify that theabove information is true and correct to the best of my knowledge. I agree to collect white-tailed deer harvestdata annually, as outlined under the Enclosure Management Assistance Program, and submit the harvest dataannually to my consulting wildlife biologist. I also agree to follow all rules defined for the use of EMAPManagement Buck and Doe Tags.Landowner Printed Name Landowner Signature Date SignedSection 19 – Consulting Wildlife Biologist AffidavitBy my signature below, I certify that I have read the above White-tailed Deer Enclosure Permit Application. Ialso certify that the above information is true and correct to the best of my knowledge.Biologist Printed Name Biologist Signature Date SignedFor MDWFP Office Use OnlyFacility ID: ____________Check or Money Order #______________Amount Received $___________Date Received: _________________Date of last Inspection________Passed Or FailedThe above applicant has met all administrate requirements set forth in Public Notice W1-3780.Place an X in one: Yes NoAuthorized MDWFP Signature Printed Name DateTitle:www.mdwpf.com