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HomeMy WebLinkAboutHunting & Fishing Licenses Amendment to Agreement 10/16/2020 B ® r- lti ® r-q r� Ln u7 m m ' OF !3 C A L U S r� r1. r%- Postage $ I ® —0 _a ��. ® Certified Fee ® ra ri Postmark .�.®� C3 C3 Return Receipt Fee Here s O p (Endorsement Required) ® C3 O Restricted Delivery Fee ® C3 O (Endorsement Required) C3 C3 rU rU Total Postage&Fees Sent T La CVenUe CCOUn 3. U1 ® KYS__Deot.__Envti og tal_Conservation Street,Apt No.; ® or PoaoXNo. 625_Broadwav,__10th Floor City,State,ZIP+4 Albany, NY 122334900 • • • ° ° ° • ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent so that.we can return-the cardio you. ❑Addressee ' 1 ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery I or on the front,if space permits. ( ` 1. Article Addressed to: D. IS delivery address different from item 1? ❑Yes ittention.- If YES,enter delivery address below: ❑No i I �eveuue & Accounting ,dint I Nys Dept. of Environ. Cons. r � 5-Broadway, 10th Floor d,e . any; NY 12233-4900 j I 3. Service Type ❑Pnority,Mail Excp esii' I 0 Adult Signature ❑Registered Wil'14 I Adult Signature Restricted Delivery ❑Registered Mad`Rgstrictedl I Certified Mad@ t1� 'Delivery-, f 95909402 5230 9122 2783 37 ❑Certified Mad Restricted Delivery ��Retum Receipt for ' 1= � ❑Collect on Delivery .`�'� McFchantlese^. h ❑Collect on Delivery Restricted Delivery ❑Slgnature ConfirmationTM I :,.,A_iticle_Num—Numservice label) ❑Insured Mad ❑Signature Confirmation I` _ — ured M 7014 1200 0001 6743 5117 ❑Insall Restricted Delivery Restricted Delivery I f; i (over$500) I � PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt � 'i"SLNDER-' C.OMP�LtTE-THIS8ECTION COMPLETE . ON . ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent so that we can return the cardio you. ❑Addressee ■ Attach this card to the back of the mailpiece, B• p' e r[�eTNeV D C Date of Delivery 1 or on the front if space permits. _II( \v/ 1. Article Addressed to: D.1 Is delivery address different from item 1 ❑Yes is tentio ® If YES,�(,� `d �9 el' e�alter El No 'Revenue nue & Ar-counting tL" IVI�1 ting UUi S Dept. of Environ Coma. NYSDEC 625 Broad-way, 10$h Floor MAILROOM 7 1, IUbany, NY 12233®4900 i3. Service Type ❑Priority Mall Express@ I II I IIIIII III III I III III IIII II II I I II I I I I III ❑Adult Signature ❑Registered Mail Adult Signature Restricted Delivery ❑Registered Mad Restricted Certified Mail@ Delivery 9590 9402 5230 9122 2783 37 ❑Certified Mad Restricted Delivery lX Return Receipt for I ❑Collect on Delivery Merchandise ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM 2._Article Number(transfer from service label) ❑Signature Confirmation — ❑Insured Mad ; )' ❑Insured Mail Restricted Delivery lRestncted Delivery 7014' 12 I b0' b001` •6743 '5117" (over$500) aPS Form 3811,July 2015 PSN 7530-02-000-9053 —^ Domestic Return Receipt' ratified Bail Provides: i A mailing receipt A unique identifier for your madpiece ' A record of delivery kept by the Postal Service for two years portant Reminders: Certified Mail may ONLY be combined with Fust-Class Mad®or Priority Mail. Certified Mail is not available for any class of international mad. NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mad For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return p Receipt(PS Form 3811)to the article and add applicable postage to cover the fee Endorse mailpiece"Return Receipt Requested" To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mad receipt is required For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the matlpiece with the ` endorsement"Restricted Delivery". If a postmark on the Certified Mad receipt is desired,please present the arti- cleat the post office for postmarking If a postmark on the Certified Mad ' a receipt is not needed,detach and affix label with postage and mad 1PORTAMP Save this receipt and present it when making an inquiry. i Form 3800,August 2006(Reverse)PSN 7530.02-000-9047 USPS IRACKAVC:# ( ! I f=irst-Class Mail ( Postage'&Fees Paid USPS Permit No.G-10 ;1 9590 9402 5230 9122 2783 37 Ii I 1 I United States °Sender.Please print your name,address,and ZIP+4®in this box* { Postal Service I t I hll.zaeth A. Iweville ! 1 Southold Town Clerk 53095 Hain Baud I P.O. Box 1179 I � I SouthoId.9 NY 11971 I I I I I � � F Neville, Elizabeth From: Neville, Elizabeth Sent: Monday, May 03, 20211:52 PMf To: 'dec.sm.Supervisor.License' Cc: Born, Sabrina; Doroski, Bonnie; Mudd,Jennifer; Rudder, Lynda; Foote, Nancy;Jobes, Craig Subject: RE: NYS DEC Training Instructions, AOR training Attachments: License Issuing Agent Qu_20210503131501.pdf Importance: High Good Afternoon, In response to your e-mails of Dec. 11, 2020 and April 30, 2021, attached please find the License Issuing Agent Quiz completed by my Deputy Town Clerk Assistant Lynda M. Rudder, as requested. I trust this is all that is required from us at this time. I look forward to hearing from you as soon as License Sales reviews the Quiz. Please confirm receipt of this e-mail and let me know if there is anything further required at this time. Thank you, Elizabeth A.Neville Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 From: dec.sm.Supervisor.License [mailto:Supervisor.License@dec.ny.gov] Sent: Friday, December 11, 2020 11:11 AM To: Neville, Elizabeth Subject: NYS DEC Training Instructions, AOR training NYS DEC Training Instructions,_AOR training '2»d,„",_. s - ,� kfi�,.�a., � -_•„�^,- ..-•---.'s^Ria._^;^4-,.,�¢^�'fi*r, ^k^r^,° ,�rr'� "r,�',;,_ -...:W� `""�""'"'°�, A' ent of r`eca'rd$re orted°to`DE"C>o`nwa reem`ent°andyth"e: erso'n who:—eeds`fo� orth'rou h DECutramin &cake°.the 9 . h p u 9 _ a_ p9_��. _ Hg._ ._ _ J� atta$cfed quizLynda M. Rudder You are receiving this email because your license issuing agreement has been reviewed and approved and criminal history checks have been completed.At this point please proceed with #3 below by reviewing the attached License Issuing Handbook. Once the handbook is reviewed please follow the rest of the instructions. NYS DEC License Sales Online Training Instructions Before beginning this process please be aware of the following: Submission of an Agent Agreement and participation in training for DEC's Automated License-issuance System (DECALS) does not guarantee that you will become a license issuing agent. Becoming an agent takes in to account 1 several factors such as, but not limited to, having a completed/valid contract on file, criminal history search results, equipment availability, training & quiz results, etc. If you wish to become an agent, please follow the steps outlined below. Please keep in mind that we will only accept applications for new license issuing agents from December 1St through June 30th annually. If all documentation is in order and your agent status is approved, you will need to allow 4-6 weeks from the submission of your completed quiz to have your agent profile created and to 'receive all the necessary equipment and supplies. How to apply to become a License Issuing Agent or Update an Agent of Record (AOR): 1.Send an email to Supervisor.License(&dec.ny.gov in which you express your interest in selling sporting licenses and the entire catalogue of sales items. Be sure to include the name';of your business or municipality, your name, phone number and address along with a brief explanation as to why,you wish to become a License Issuing Agent. If you are reporting the change of an AOR be sure to provide your agent*, name of your location, name of the new AOR and any other changes (Please note, changes in AOR will require a new agreement and for the new AOR to meet all training requirements listed below). 2.After reviewing your email, the DEC will send you the License Issuing,Agreement. If you have questions about filling out the agreement you can contact Revenue at Elizabeth.lover!ng0dec.ny.gov or 1-800-962-5622. Once you complete the agreement you must mail it to New York State Department of Environmental Conservation, Attn: Revenue and Accounting Unit, 625 Broadway 10th Floor,Albany, New York 12233-4900. If we are unable to add additional agents, we will let you know and provide a suggested time to reapply. 3.Once your agreement has been reviewed for completeness, we will proceed with criminal history checks and provided those pass we will reply to your email with the License Issuing Handbook and the quiz so you can learn the business rules behind selling the items in the DECALS catalogue and take the quiz. 4.After completing the quiz, email it back to Supervisor.License(aD-dec.ny.gov. Make sure to complete all questions and fill in the information requested at the end of the quiz. Please note, only the AOR at each location must take the quiz. When filling in the answer sheet please be sure that your answers are A, B, C, D, etc...not True or False, Yes, No. Also, keep in mind that there is only 1 answer per,question. Additionally, due to our busy season, limited staff and a huge increase in requests to change the Agent of Record (AOR) at agent locations it will take longer than other times of the year to respond. I will be reviewing emails in the order they are received, and you will get an email from me after your quiz is reviewed. 5.License Sales will review the quiz and information provided and then contact Revenue to let them know that training has been completed. At this time, you will be directed to take an additional training that covers the functionality of the DECALS software along with instructions on the printer installation. If you are a new agent haven't received a printer yet, you will need to access this part of the training once you'receive the new printer. Additionally, if the person taking the quiz does not receive a passing grade (70%) after their second attempt at the quiz we will not be able to establish the location as an agent with this person being on record as the DEC trained person/AOR. 6.Once License Sales and Revenue approve your submission, we will arrange for the shipment of your License Printer and arrange for the shipment of the License Paper(Valeron), Hunting &Trapping Guides and Fishing Guides. These items will be shipped to the address provided at the bottom of your quiz answer sheet so please be sure that this information is correct and complete (shipping address cannot be a PO Box). Since these items are not all shipped from the same location you may not receive them all at once. If you have questions about the training process feel free to contact our office at: Supervisor.License(&dec.nv.gov or(518)402-8843 If you have questions about the contract, please contact Revenue at: Elizabeth.loverine@dec.nmov or 1-800-962-5622 Please note that the quickest way to get your concerns addressed is to use the email addresses provide above. Kevin Maloney NYS DEC License Sales 2 Neville, Elizabeth From: dec.sm.Supervisor.License <Supervisor.License@dec.ny.gov> Sent: Friday, December 11, 2020 11:11 AM To: Neville, Elizabeth Subject: NYS DEC Training Instructions,AOR training Attachments: Agent.Quiz 3.Questions.kalkomey.7-8-20.docx NYS DEC Training Instructions, AOR training Agenf,ofrec'ord;re d,to:'DEC on agreement'ard.tFi` `pe9rs' n vvh ' ' N 't ainin - �' e- o o��needs�,tokgo„tfiro�ughDECt,`� _gr&xtake�the attached°quiLynda M. Rudder You are receiving this email because your license issuing agreement has been reviewed and approved and criminal history checks have been completed.At this point please proceed with#3 below by reviewing the attached License Issuing Handbook. Once the handbook is reviewed please follow the rest of the instructions. NYS DEC License Sales Online Training Instructions Before beginning this process please be aware of the following: Submission of an Agent Agreement and participation in training for DEC's Automated License-issuance System (DECALS) does not guarantee that you will become a license issuing agent. Becoming an agent takes in to account several factors such as, but not limited to, having a completed/valid contract on file, criminal history search results, equipment availability, training &quiz results, etc. If you wish to become an agent, please follow the steps outlined below. Please keep in mind that we will only accept applications for new license issuing agents from December 1St through June 30th annually. If all documentation is in order and your agent status is approved, you will need to allow 4-6 weeks from the submission of your completed quiz to have your agent profile created and to receive all the necessary equipment and supplies. How to apply to become a License Issuing Agent or Update an Agent of Record (AOR): 1.Send an email to Supervisor.License(a-)-dec.nv.nov in which you express your interest in selling sporting licenses and the entire catalogue of sales items. Be sure to include the name of your business or municipality, your name, phone number and address along with a brief explanation as to why you wish to become a License Issuing Agent. If you are reporting the change of an AOR be sure to provide your agent#, name of your location, name of the new AOR and any other changes (Please note, changes in AOR will require a new agreement and for the new AOR to meet all training requirements listed below). 2.After reviewing your email, the DEC will send you the License Issuing Agreement. If you have questions about filling out the agreement you can contact Revenue at Elizabeth.lovering(cDcliec.ny.gov or 1-800-962-5622. Once you complete the agreement you must mail it to New York State Department of Environmental Conservation, Attn: Revenue and Accounting Unit, 625 Broadway 10th Floor, Albany, New York 12233-4900. If we are unable to add additional agents, we will let you know and provide a suggested time to reapply. 3.Once your agreement has been reviewed for completeness, we will proceed with criminal history checks and provided those pass we will reply to your email with the License Issuing Handbook and the quiz so you can learn the business rules behind selling the items in the DECALS catalogue and take the quiz. 4.After completing the quiz, email it back to Supervisor.License@dec.ny.gov. Make sure to complete all questions and fill in the information requested at the end of the quiz. Please note, only the AOR at each location must take the quiz. When filling in the answer sheet please be sure that your answers are A, B, C, D, etc...not True or False, Yes, No. Also, keep in mind that there is only 1 answer per question. Additionally, due to our busy season, limited staff and a huge increase in requests to change the Agent of Record (AOR) at agent locations it will take longer than other times of the year to respond. I will be reviewing emails in the order they are received, and you will get an email from me after your quiz is reviewed. 5.License Sales will review the quiz and information provided and then contact Revenue to let them know that training has been completed. At this time, you will be directed to take an additional training that covers the functionality of the DECALS software along with instructions on the printer installation. If you are a new agent haven't received a printer yet, you will need to access this part of the training once you receive the new printer. Additionally, if the 1 person taking the quiz does not receive a passing grade (70%) after their second attempt at the quiz we will not be able to establish the location as an agent with this person being on record as the DEC trained person/AOR. 6.Once License Sales and Revenue approve your submission, we will arrange for the shipment of your License Printer and arrange for the shipment of the License Paper(Valeron), Hunting &Trapping Guides and Fishing Guides. These items will be shipped to the address provided at the bottom of your quiz answer sheet so please be sure that this information is correct and complete (shipping address cannot be a PO Box). Since these items are not all shipped from the same location you may not receive them all at once. If you have questions about the training process feel free to contact our office at: Supervisor.LicenseAdec.nv.gov or(518)402-8843 If you have questions about the contract, please contact Revenue at: Elizabeth.love rine@dec.ny.eov or 1-800-962-5622 Please note that the quickest way to get your concerns addressed is to use the email addresses provide above. Kevin Maloney NYS DEC License Sales 2 Agent.Quiz 3.Questions.Kalkomey.7-8-20 Office Use Only On Agent Listing on DEC website? Y/ N Answer Sheet: 2. 12. 3. 13� 4. Ci 14. A 5. A 15. C 6 16. 7. 17.� 8. C. 18. 9.� 19.� 10. � 20. Name of Test Taker: Ljrx ,c,,_ 14\ \\vAAe Y Date-of-Birth__a a a ^ 44 (Please print legibly) Agent ID- 0 15q or circle NEW Name of Business. L Owen C9 O l� � ®uin Physical Address (Street/City/State/Zip Code): Q.l,`(l Qo-A Lq Shipping Address (Street/City/State/Zip Code): OL�� (UPS CANNOT SHIP TO A PO BOX) County. S U-�-�O L Daytime Phone# ( ) ! -- I foo Email Address e,,nP—Q,L\1e. C040k-on . SOUANIA- (N\� - us • Do you have a Zebra License Pnnter?(�)or N • Do you have Valeron (License Paper)? Dor N • Do you have Hunting and/or Fishing Guides?&r N If NO how many do you needy Hunting Guides Fishing Guides Agent.Quiz 3.Questions.Kalkomey.7-8-20 License Issuing Agent Quiz 1. If a person from New Jersey pays income taxes to New York State, they are eligible for resident-price licenses. A. True B. False 2. The Patriot Plan provides free hunting, fishing and/or trapping licenses to full-time active-duty service-members who are New York residents stationed in New York. A. True B. False 3. An individual must be a resident of New York for 30 days before becoming eligible to purchase a Lifetime License. A. True B False 4 Which is NOT acceptable proof of residency? A. New York State income tax information (W-2) B Religious verification C Three months'worth of utility bills D. NYS Non-driver's identification card with a valid New York address 5. You can accept a hunter's education certificate or previous hunting license from any state or country no matter how old. A. True B. False 6 A 50% military disabled resident of New Jersey is eligible for a New York State military disabled reduced-fee license. A True B False 7. What is the minimum acreage a landowner must have to qualify for the landowners permit? A. 30 B. 40 C 50 D. 10 8. Which of these items can be voided? A Deer Management Permits B. Lifetime licenses C Junior hunting licenses D Replacement carcass tags 9. Donna, a landowner with two tax map IDs of contiguous land (20 acres in one parcel and 40 acres in the other), applies for a Deer Management Permit. Will she be eligible for a landowner's preference? A. Yes B No 10. An agent issued the wrong Wildlife Management Unit for a customer's deer management permit(DMP), who should call the DMP hotline for help? A Agent B Customer C Either Agent or Customer D No one 11 A New York State resident with a non-military related disability qualifies for a discounted hunting & fishing licenses. A. True B False ,M a r I f Neville, Elizabeth From: dec.sm.Supervisor.License <Supervisor.License@dec ny.gov> Sent: Friday, April 30, 20211:30 PM To: Neville, Elizabeth; dec.sm.Supervisor.License Cc: Rudder, Lynda; Born, Sabrina; Lovering, Elizabeth A (DEC); Doroski, Bonnie; Mudd, Jennifer;Jobes, Craig; Foote, Nancy Subject: RE:Town of Southold Agent ID#2059 Attachments: NYS DEC Training Instructions, AOR training ; 2015-2016 Entire License Issuing Handbook .pdf I looked back at this and it appears I sent the attached email to you on 12/11/2020.This email contains the training instructions needed along with the quiz. From what I am seeing I don't see where the quiz was returned to us. If you go r through the training and take the quiz and return it, we can move things forward and get you set uL. Please keep in mind, after June 30th, we will not be able to process such requests until after the busy season is over in December. Thanks, Kevin From: Neville, Elizabeth <E.Neville@town.southold.ny.us> Sent: Friday,April 30, 202111:51 AM To:dec.sm.Supervisor.License<Supervisor.License @dec.ny.gov> Cc: Rudder, Lynda <Ivnda.rudder@town.southold.ny.us>; Born, Sabrina <sabrina.born@town.southold.nv.us>; Doroski, Bonnie<Bonnie.Doroski@town.southold.nV.us>; Mudd,Jennifer<jennifermu@southoldtownny.gov>;Jobes, Craig <craigi southoldtownny.gov>; Foote, Nancy<nancy.foote@town.southold.nv.us> Subject:Town of Southold Agent ID#2059 Importance: High MOWN- Good Morning, Six(6) months have passed since my initial attempt to renew my"Licensing Issuing Agent Agreement" and change my Assistant License Issuing Agent from Carol Hydell (as she has longer works in my office)to my Deputy Town Clerk Lynda M. Rudder. Many attempts have been made since,all unsuccessful. As a result we are not able to issue any NYS DEC Conservation Hunting or Fishing Licenses in this office. In speaking with Vendor support 347 227-0452 this morning, I was told that we still do not have a connection to the new licensing issuing system. The above attachment contains the signed agreement, Southold Town Board Resolution no. 2020-703 and all related forms and documents which were mailed to you by Certified Mail on October2l, 2020 and received by you on October 26, 2020 as indicated by your NYSDEC Stamp. I would like an explanation of why the NYS DEC has not corrected this situation. Elizabeth A.Neville Southold Town Clerk, Registrar of Vital Statistics Records Management Officer; FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800, Ext. 228 1 Neville, Elizabeth To: dec.sm.Supervisor.License Subject: RE: NYS DEC Training Instructions,AOR training Good Afternoon, In response to your e-mail,attached please find the License Issuing Agent quiz completed by my Deputy Town Clerk Lynda M. Rudder, as requested. From: dec.sm.Supervisor.License [mailto:Supervisor.License@dec.ny.gov] Sent: Friday, December 11, 2020 11:11 AM To: Neville, Elizabeth Subject: NYS DEC Training Instructions, AOR training NYS DEC Training Instructions, AOR training Ag } a'4 DCE,.._o a`g'ree '!�e_n anri tehri e p rskon uDECna kte66 ireco gh .tne fcord r0 d t i�-11 atach_edLynda M. Rudder You are receiving this email because your license issuing agreement has been reviewed and approved and criminal history checks have been completed. At this point please proceed with #3 below by reviewing the attached License Issuing Handbook. Once the handbook is reviewed please follow the rest of the instructions. NYS DEC License Sales Online Training Instructions Before beginning this process please be aware of the following: Submission of an Agent Agreement and participation in training for DEC's Automated License-issuance System (DECALS) does not guarantee that you will become a license issuing agent. Becoming an agent takes in to account several factors such as, but not limited to, having a completed/valid contract on file, criminal history search results, equipment availability, training &quiz results, etc. If you wish to become an agent, please follow the steps outlined below. Please keep in mind that we will only accept applications for new license issuing agents from December 1St through June 30th annually. If all documentation is in order and your agent status is approved, you will need to allow 4-6 weeks from the submission of your completed quiz to have your agent profile created and to receive all the necessary equipment and supplies. How to apply to become a License Issuing Agent or Update an Agent of Record (AOR): 1.Send an email to Supervisor.License(a)dec.ny.gov in which you express your interest in selling sporting licenses and the entire catalogue of sales items. Be sure to include the name of your business or municipality, your name, phone number and address along with a brief explanation as to why you wish to become a License Issuing Agent. If you are reporting the change of an AOR be sure to provide your agent#, name of your location, name of the new AOR and any other changes (Please note, changes in AOR will require a new agreement and for the new AOR to meet all training requirements listed below) 2.After reviewing your email, the DEC will send you the License Issuing Agreement. If you have questions about filling out the agreement you can contact Revenue at Elizabeth.lovering(aDdec.ny.gov or 1-800-962-5622. Once you complete the agreement you must mail it to New York State Department of Environmental Conservation, Attn: Revenue and Accounting Unit, 625 Broadway 10th Floor, Albany, New York 12233-4900. If we are unable to add additional agents, we will let you know and provide a suggested time to reapply 3.Once your agreement has been reviewed for completeness, we will proceed with criminal history checks and provided those pass we will reply to your email with the License Issuing Handbook and the quiz so you can learn the business rules behind selling the items in the DECALS catalogue and take the quiz. 4.After completing the quiz, email it back to Supervisor.LicenseCa)dec.ny.gov. Make sure to complete all questions and fill in the information requested at the end of the quiz. Please note only the AOR at each location must take the quiz. When filling in the answer sheet please be sure that your answers are A, B, C, D, etc. .not True or False, Yes, No. Also, keep in mind that there is only 1 answer per question. Additionally, due to our busy season, 1 Agent.Quiz 3.Questions.Kalkomey.7-8-20 Office Use Only -On-,Aeentlistine=on DEC website? Y/N Answer Sheet: 3. 13. 4.�n 14 A , - 5. 15. 7. 17.x, -- - 8., C 18. sr� `7 �,� Name of Test Taker:� �,� t ! � �a ��y' _ Date-of-Birth JA c "' (Please print legibly) Agent ID: or circle NEIN Name of Business: Physical Address(Street/City/State/Zip Code): l 1 Shipping Address (Street/City/State/Zip Code): (UPS CANNOT SHIP TO A PO BOX) County:. Daytime Phone#. _) Email Address: e,, _ P-,.Q" 1Ve- o', Do you have a Zebra License Printer? or N • Do you have Valeron (License Paper)?Dor N ® Do you have Hunting and/or Fishing Guides?&r, N If NO how many do you need? Hunting Guides Fishing Guides Agent.Quiz 3.Questions.Kalkomey.7-8-20 License lss,66i.ng Agen't 'QUiz 1. If a person from New Jersey pays income taxes to New York State, they are eligible for resident-price licenses. A. True f B. False 2. The Patriot Plan provides free hunting, fishing and/or trapping licenses to full-time active-duty service-members who are New York residents stationed in New York. ' A. True B. False 3. An individual must be a resident of New York for 30 days before becoming eligible to purchase a Lifetime License, A. True B. False a 4. Which is NOT acceptable proof of residency? A. New York State income tax information (W-2) B. Religious verification C. Three months'worth of utility bills s D. NYS Non-driver's identification card with a valid New York address 5. You can accept a hunter's education certificate or previous hunting license,from any state or country no matter how olds,. A. True B. False 6. A 50%military disabled resident of New Jersey is eligible for a New York State military disabled reduced-fee license. A. True i B. False 7. What is the minimum acreage a landowner must have to qualify for the landowners permit? A. 30 B. 40 C. 50 D. 10 8. Which of these items•can be voided? A. Deer Management Permits B. Lifetime licenses C. Junior hunting licenses D. Replacement carcass tags 9. Donna, a landowner with two tax map IDs of contiguous land (20 acres in one parcel and 40 acres in the other), applies for a Deer Management Permit.Will she be eligible for a landowner's preference? A. Yes B. No 10. An agent issued the wrong Wildlife Management Unit for a customer's deer-management permit(DMP), who should call the DMP hotline for help? A. Agent B. Customer C. Either Agent or Customer D. No one 11. A New York State resident with a non-military related disability qualifies for a discounted hunting &fishing licenses, A. True B. False Agent-Quiz 3.Questions.Kalkomey.7-8-20 12 If a customer presents a license issuing agent a previous years New York State hunting and/or fishing license they will then qualify for the current year's license at a New York State resident price. A. True B. False 13. Todd lost his back tag, Marine Registry(saltwater fishing license) and freshwater fishing license. How much will it cost him to have them replaced? A. $0 B. $5 C. $10 D. $15 14. Alisia has not purchased a bowhunting license in many years but still has her last bowhunting license from 1976. Alisia can present this previous license to a license issuing agent in order to qualify for her bowhunting privilege. A. True B False 15 What can be used to prove residency for a minor? A. Parents driver's license B. Grandparent's driver's license C. Birth certificate D. All of the above 16. Timmy would like to buy a Lifetime License. Does he need Sportsman education in order to make the purchase? A. Yes B. No 17. After collecting a Certification of Military Active Service Status form from a customer, agents must retain the form for how long? A. Six months B. One year C. Two years D. Three years 18. At what age can a NYS resident qualify for the Senior priced licenses? A. 60 B. 65 C. 70 D 75 19. Agents must see and verify each customers proof of residency each time they wish to purchase items at a NYS resident price A. True B. False 20. The chances of selection for a DMP are the same on the first day of DMP sales as they are when the DMP application period ends on October 1st. A. True B. False Agent.Quiz 3.Questions.Kalkomey.7-8-20 12 If a customer presents a license issuing agent a previous years New York State hunting and/or fishing license they will then qualify for the current year's license at a New York State resident price A. True B. False 13. Todd lost his back tag, Marine Registry (saltwater fishing license) and freshwater fishing license. How much will it cost him to have them replaced? A. $0 ^5 C. $10 D $15 14 Alisia has not purchased a bowhunting license in many years but still has her last bowhunting license from 1976. Alisia can present this previous license to a license issuing agent in order to qualify for her bowhunting privilege. A. True B. False 15 What can be used to prove residency for a minor? A. Parents driver's license B. Grandparent's driver's license C. Birth certificate D All of the above 16. Timmy would like to buy a Lifetime License. Does he need Sportsman education in order to make the purchase? A. Yes B. No 17. After collecting a Certification of Military Active Service Status form from a customer, agents must retain the form for how long? A. Six months B. One year C. Two years D. Three years 18 At what age can a NYS resident qualify for the Senior priced licenses? A. 60 B. 65 C. 70 D 75 19. Agents must see and verify each customers proof of residency each time they wish to purchase items at a NYS resident price. A True B. False 20 The chances of selection for a DMP are the same on the first day of DMP sales as they are when the DMP application period ends on October 1St A. True B. False Agent.Quiz 3.Questions.Kalkomey.7-8-20 Office Use Oniy On Agent Listing on DEC website? Y/N Answer Sheet: 2.A 12.� 3.� 13. ` 4. Ci 14.$ 5. A 15.C_ 6. 16. 7. C 17.� 8. 18. G 9.� 19. - Pt 10.� 20. Name of Test Taker: �Up(I►y�IL �. -Do rzt, Date-of-Birth— to -C(- 59 q (Please print legibly) Agent ID: s t or circle NEW Name of Business: l pu.V` OT Soso�d� Physical Address (Street/City/State/Zip Code): Shipping Address (Street/City/State/Zip Code). _- SlG (UPS CANNOT SHIP TO A PO BOX) County: J�1T�p�k— Daytime Phone#: Email Address: Lj • Do you have a Zebra License Printer or N ® Do you have Valeron (License Paper01Y or N • Do you have Hunting and/or Fishing GuidesP Y dr N If NO how many do you need? Hunting Guides Fishing Guides Agent.Quiz 3.Questions.Kalkomey.7-8-20 Office Use Only On Agent Listing on DEC website? Y/ N Answer Sheet: 2. 12. 2 3. 13. 6 4. c- 14. 5. 15.� 6. 16. 1b 7. (, 17. I> 8.�� 18. C., 9. A 19. 10 20. Name of Test Taker: PA • Date-of-Birth (Please print legibly) Agent ID: 2 S or circle NEW Name of Business 0 W Physical Address (Street/City/State/Zip Code): KI Y 117-71 Shipping Address (Street/City/State/Zip Code). Ra-;. r---v 2-8 (UPS CANNOT SHIP TO A PO BOX) ` *d Y - r County. ��lt Daytime Phone#: Email Address. C,. n V I I �ol�Y1•��IJ�(� LU ��• us • Do you have a Zebra License Printer?®or N • Do you have Valeron (License Paper)?(9 or N • Do you have Hunting and/or Fishing Guides26or N If NO how many do you needy Hunting Guides Fishing Guides 2 UNI TED MTES_. S��L SERVICE. SOUTHOLD 710 TRAVELER Sr SOUTHOLD, NY 11971-1000 (800)275-8777 10/21/2020 04:58 PM ----- ---------------------------------- Product----- Qty Unit Pric, Price ------------------- Prepaid Mai ---------�- l $0.00 Weight: 0 ib 3.10 oz Acceptance Date. Wed 10/21/2020 Tracking #: 70141200000167435094 ---------------------------------- ---------- Grand Total : $0.00 Preview your Mail Track your Packages Sign up for FREE ® , www.informeddeli�very.com All sales final on stamps and postage. .. e Refunds for guaranteed services only. E' © , Thank you for your business. 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Article NUmberLIFaCtSlecfrOrrUi_SeLvfCeJa6e11. _Y Collect on Delivery Restricted Delivery D Signature ConSrmatidnTM a Insured Mad ❑Signature confirmation 7 014 1200 0001 6743 5094 ❑Insured Mail Restncted Delivery Restr clad Delivery , (over$500) PS Form 3811.112015 PSN 7530-02-000-9053 Domestic Return Receipt 1 SOUTHOLD 710 TRAVELER Sf SOUTHOLD, NY 11971-1000 10/21/2020 (800)275-8777 04:58 PM 1 Product Qty Unit Pric, Price -- ---------------- Prepaid Mail --/- - 1-- $0,00 (I Weight: 0 lb 3.10 oz I *d 1 ' Date:nce 21/2020 Tracking; #: k— '70141200000167435094 I ----------------- Grand Total : $0.00 ----------------- ------------------- ;Preview your Mail Ira k your Packages �� Sign up for FREE @ o a - www.i l-if ormeddel i very,com y , ',,, =r'' ,4.r,.,_ t ,r,,dµ '%tr'.��. - ;ly All sales final on stamps and postage. Refunds for guaranteed services only. Er _ Io a Thank you for your business. un ), i 7 F ON Cy 411. L-1 Tell us about ur experience. m " �- Go t0: 11ttpS:/ ost jl a , om/Pos i ry Postage $ 840-511 0170-0 -0002 42.75- 2 ,.n or scan th' code with your it bile d vice, ; � Certified Fee ® alit C3 Return Receipt Fee 21 Will ® C3 (Endorsement Required) He e ® ®g� Restricted Delivery Fee ■ (Endorsement Required) C3 SPS I ® M Total Postage&Fees r$ o Sent To _ C3 Strea,Ap No.; J ®q or call 1-800-410-7420. CiyOBoxNo. DIS or 41d_WA _i_9 FUlaX-____ City St e,ZI +4� 2 ®® UFN: 358000-0971 Receipt # 840-51170170-3-2804275-2 Clark: 2 ® ® ° plate items 1,02,and 3. A. Signature lyour name and address on the reverse X 13 Agent Fit we can return the cardio you. El Addressee -- 1011—Alta—ch A-ftach this card to the back of the mailpiece, B. Received by(Printed Name) O. Date of Delivery - or on the front if space permits. _ 1. Article Addressed to: D. Is•dehvery"'adaress,different from'item ly ❑Yes A' 1 If YES,;enter delivery address below:% ❑No 20 V-00A � , 10th 1=1wr � OCT � '� c.Q� 1 bav><y, MY r X3.3 o y ® II I IIIII IIII III I III III IIII I II II I I I III I III 3."Service Type—-- - " _ ❑Registered Mad ailUi sO ❑Adult Signature ❑Registered MaiIT^� ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 5230 9122 2783 75 Certified Mad® Delivery i Certified Mad Restricted Delivery Return Receipt for ❑Collect on Delivery f Merchandise 2. Article Number(T/ans_fer from service label) _ 11 Collect on Delivery Restricted Delivery ii signature confirmationTM - Insured Mad ❑Signature Confirmation 7 014 1200 0001 6 7 4 3 5094 ❑Insured Mail Restricted Delivery Restricted Delivery i (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 30, 20213:26 PM To: Rudder, Lynda Cc: Born, Sabrina; Doroski, Bonnie; Mudd,Jennifer Subject: NYS DEC Licensing I do not recall seeing their e-mail on December 11, 2020. At that point in time I could have missed it or it could have gone to SPAM. However...... On Monday, please read the handbook and do the quiz and return to me. I will both e- mail and USPS Certified Mail the Quiz to them ASAP. Hopefully, we can get things going. Betty Elizabeth A.Neville Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 1 Neville, Elizabeth From: dec.sm.Supervisor.License <Supervisor.License@dec.ny.gov> Sent: Friday,April 30, 20211:30 PM To: Neville, Elizabeth; dec.sm.Supervisor.License Cc: Rudder, Lynda; Born, Sabrina; Lovering, Elizabeth A (DEC); Doroski, Bonnie; Mudd, Jennifer;Jobes, Craig; Foote, Nancy Subject: RE:Town of Southold Agent ID#2059 Attachments: NYS DEC Training Instructions,AOR training ;2015-2016 Entire License Issuing Handbook .pdf I looked back at this and it appears I sent the attached email to you on 12/11/2020.This email contains the training instructions needed along with the quiz. From what I am seeing I don't see where the quiz was returned to us. If you go through the training and take the quiz and return it, we can move things forward and get you set up. Please keep in mind, after June 30th, we will not be able to process such requests until after the busy season is over in December. Thanks, Kevin From: Neville, Elizabeth<E.Neville @town.southold.nv.us> Sent: Friday,April 30, 202111:51 AM To:dec.sm.Supervisor.License<Supervisor.License @dec.ny.gov> Cc: Rudder, Lynda <Ivnda.rudder@town.southold.nv.us>; Born,Sabrina <sabrina.born@town.southold.ny.us>; Doroski, Bonnie<Bonnie.Doroski @town.southo Id.ny.us>; Mudd,Jennifer<lennifermu@southoldtownny.gov>;Jobes, Craig <craigi@southoldtownny.goy>; Foote, Nancy<nancy.foote@town.southold.nv.us> Subject:Town of Southold Agent ID#2059 Importance: High Good Morning, Six(6) months have passed since my initial attempt to renew my"Licensing Issuing Agent Agreement" and change my Assistant License Issuing Agent from Carol Hydell (as she has longer works in my office)to my Deputy Town Clerk Lynda M. Rudder. Many attempts have been made since, all unsuccessful. As a result we are not able to issue any NYS DEC Conservation Hunting or Fishing Licenses in this office. In speaking with Vendor support 347 227-0452 this morning, I was told that we still do not have a connection to the new licensing issuing system. The above attachment contains the signed agreement, Southold Town Board Resolution no. 2020-703 and all related forms and documents which were mailed to you by Certified Mail on October2l, 2020 and received by you on October 26, 2020 as indicated by your NYSDEC Stamp. I would like an explanation of why the NYS DEC has not corrected this situation. Elizabeth A.Neville Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 1 Neville, Elizabeth From: dec.sm.Supervisor.License <Supervisor.License@dec.ny.gov> Sent: Friday, December 11, 2020 11:11 AM To: Neville, Elizabeth Subject: NYS DEC Training Instructions,AOR training Attachments: Agent.Quiz 3.Questions.kalkomey.7-8-20.docx NYS DEC Training Instructions, AOR training Age..—n>t�om Ure-c.,...o_,..rd,.y-rr"e-'=CA-- 'ty �'.� C on--: -,-ag. +e•e atta"hie "'6zLynda M. Rudder k__ d ,xr^i.iwze.n.."t-ya„�n'd<�u�tr_ide e�•erson-`wa._- _h.ryo.;nejie'`eds-,.to..goh- �tt- ror t�gii'DEC,-t,„tr*a_iin_in_g°&tak„Gem- irctr�e You are receiving this email because your license issuing agreement has been reviewed and approved and criminal history checks have been completed.At this point please proceed with#3 below by reviewing the attached License Issuing Handbook. Once the handbook is reviewed please follow the rest of the instructions. NYS DEC License Sales Online Training Instructions Before beginning this process please be aware of the following: Submission of an Agent Agreement and participation in training for DEC's Automated License-issuance System (DECALS)does not guarantee that you will become a license issuing agent. Becoming an agent takes in to account several factors such as, but not limited to, having a completed/valid contract on file, criminal history search results, equipment availability, training & quiz results, etc. If you wish to become an agent, please follow the steps outlined below. Please keep in mind that we will only accept applications for new license issuing agents from December 1St through June 30th annually. If all documentation is in order and your agent status is approved, you will need to allow 4-6 weeks from the submission of your completed quiz to have your agent profile created and to receive all the necessary equipment and supplies. How to apply to become a License Issuing Agent or Update an Agent of Record (AOR): 1.Send an email to Supervisor.License(cDdec.nv.gov in which you express your interest in selling sporting licenses and the entire catalogue of sales items. Be sure to include the name of your business or municipality, your name, phone number and address along with a brief explanation as to why you wish to become a License Issuing Agent. If you are reporting the change of an AOR be sure to provide your agent#, name of your location, name of the new AOR and any other changes (Please note, changes in AOR will require a new agreement and for the new AOR to meet all training requirements listed below). 2.After reviewing your email, the DEC will send you the License Issuing Agreement. If you have questions about filling out the agreement you can contact Revenue at Elizabeth.lovering(a_dec.ny.gov or 1-800-962-5622. Once you complete the agreement you must mail it to New York State Department of Environmental Conservation, Attn: Revenue and Accounting Unit, 625 Broadway 10th Floor, Albany, New York 12233-4900. If we are unable to add additional agents, we will let you know and provide a suggested time to reapply. 3.Once your agreement has been reviewed for completeness, we will proceed with criminal history checks and provided those pass we will reply to your email with the License Issuing Handbook and the quiz so you can learn the business rules behind selling the items in the DECALS catalogue and take the quiz. 4.After completing the quiz, email it back to Supervisor.License(c-dec.ny.gov. Make sure to complete all questions and fill in the information requested at the end of the quiz. Please note, only the AOR at each location must take uiz. When filling in the answer sheet please be sure that your answers are A, B, C, D, etc...not True or False, Yes, No Also, keep in mind that there is only 1 answer per question. Additionally, due to our busy season, limited staff and a huge increase in requests to change the Agent of Record (AOR) at agent locations it will take longer than other times of the year to respond. I will be reviewing emails in the order they are received, and you will get an email from me after your quiz is reviewed. 5.License Sales will review the quiz and information provided and then contact Revenue to let them know that training has been completed. at this time, you will be directed to take an additional training that covers the functionalityof the DECALS software along with instructions on the printer installa'on_ If you are a new agent haven't received a printer yet, you will need to access this part of the training once you receive the new printer. Additionally, if the 1 person taking the quiz does not receive a passing grade (70%) after their second attempt at the quiz we will not be able to establish the location as an agent with this person being on record as the DEC trained person/AOR. 6.Once License Sales and Revenue approve your submission, we will arrange for the shipment of your License Printer and arrange for the shipment of the License Paper(Valeron),;Hunting &Trapping Guides and Fishing Guides. These items will be shipped to the address provided at the bottom of your quiz answer sheet so please be sure that this information is correct and complete (shipping address cannot be a PO Box). Since these items are not all shipped from the same location you may not receive them all at once. If you have questions about the training process feel free to contact our office at: Supervisor1icense0dec.ny.gov or(518)402-8843 If you have questions about the contract, please contact Revenue at: Elizabeth.lover!ne@dec.ny.gov or 1-800-962-5622 Please note that the quickest way to get your concerns addressed is to use the email addresses provide above. Kevin Maloney NYS DEC License Sales 2 Agent.Quiz 3.Questions.Kalkomey.7-8-20 License Issuing Agent Quiz 1. If a person from New Jersey pays income taxes to New York State, they are eligible for resident-price licenses. A. True B. False 2. The Patriot Plan provides free hunting, fishing and/or trapping licenses to full-time active-duty service-members who are New York residents stationed in New York. A. True B. False 3. An individual must be a resident of New York for 30 days before becoming eligible to purchase a Lifetime License. A. True B. False 4. Which is NOT acceptable proof of residency? A. New York State income tax information (W-2) B. Religious verification C. Three months'worth of utility bills D. NYS Non-driver's identification card with a valid New York address 5. You can accept a hunter's education certificate or previous hunting license from any state or country no matter how old. A. True B. False 6. A 50% military disabled resident of New Jersey is eligible for a New York State military disabled reduced-fee license. A. True B. False 7. What is the minimum acreage a landowner,must have to qualify for the landowners permit? A. 30 B. 40 C. 50 D. 10 8. Which of these items can be voided? A Deer Management Permits B. Lifetime licenses C Junior hunting licenses D. Replacement carcass tags 9. Donna, a landowner with two tax map IDs of contiguous land (20 acres in one parcel and 40 acres in the other), applies for a Deer Management Permit.Will she be eligible for a landowner's preference? A. Yes B. No 10. An agent issued the wrong Wildlife Management Unit for a customer's deer management permit(DMP), who should call the DMP hotline for help? A. Agent B. Customer C. Either Agent or Customer D. No one 11. A New York State resident with a non-military related disability qualifies for a discounted hunting &fishing licenses. A. True B. False Agent.Quiz 3.Questions.Kalkomey.7-8-20 12. If a customer presents a license issuing agent a previous years New York State hunting and/or fishing license they will then qualify for the current year's license at a New York State resident price. A. True B. False 13. Todd lost his back tag, Marine Registry (saltwater fishing license) and freshwater fishing license. How much will it cost him to have them replaced? A. $0 B. $5 C. $10 D. $15 14. Alisia has not purchased a bowhunting license in many years but still has her last bowhunting license from 1976. Alisia can present this previous license to a license issuing agent in order to qualify for her bowhunting privilege. A. True B. False 15. What can be used to prove residency for a minor? A. Parents driver's license B. Grandparent's driver's license C. Birth certificate D. All of the above 16. Timmy would like to buy a Lifetime License. Does he need Sportsman education in order to make the purchase? A. Yes B. No 17. After collecting a Certification of Military Active Service Status form from a customer, agents must retain the form for how long? A. Six months B. One year C. Two years D. Three years 18. At what age can a NYS resident qualify for the Senior priced licenses? A. 60 B. 65 C. 70 D. 75 19. Agents must see and verify each customers proof of residency each time they wish to purchase items at a NYS resident price. A. True B. False 20. The chances of selection for a DMP are the same on the first day of DMP sales as they are when the DMP application period ends on October 1st A. True B. False Agent.Quiz 3.Questions.Kalkomey.7-8-20 'Office Use Only On Agent-Listing on DECD°website?. Y/N Answer Sheet: 2. 12. 3. 13. 4. 14. e 5. 15. 8. 18. 9. 10. 20. ,v Name of Test Taker: Date-of-Birth (Please print legibly) Agent ID: or circle NEW Name of Business: Physical Address (Street/City/State/Zip Code): Shipping Address (Street/City/State/Zip Code): (UPS CANNOT SHIP TO A PO BOX) County: Daytime Phone#: ( ) -- Email Address: • Do you have a Zebra License Printer? Y or N • Do you have Valeron (License Paper)? Y or N • Do you have Hunting and/or Fishing Guides? Y or N If NO how many do you need? Hunting Guides Fishing Guides h l (� Residency Requirements To apply for a Resident License, customers must present proof that they are legal residents of New York State. Owning property in NYS does not constitute residency. You can only issue a Resident License to customers who show one of the Residency Proofs listed below. Acceptable Residency Proofs 1) Current New York State Driver's License 2) Current New York State Non-Driver's ID with A VALID NY ADDRESS 3) Current New York State Income Tax Information (W-2) 4) Current Voter Registration card or current letter from Board of Elections 5) Current Student ID or a letter from the registrar 6) Religious Verification (Amish, etc.) 7) Military LES/Orders 8) Current parent's residency proof for a minor 9) Current pay stub that shows a NYS address and at least four weeks of employment in the state. In order to purchase an annual license as a resident,the individual must reside in NYS for at least 30 days. To purchase a Lifetime License,the individual must prove NYS residency for one year. Resident Active Duty Military stationed outside New York State and home on leave for 30 days or less are eligible for a free fishing, hunting, and trapping license under the Patriot Plan. They have to fill out the Certification of Military Active Service Status form (located in the Agent Help Link) and the license issuing agent must keep this form on file for three years. Non-resident Military Personnel stationed in New York State are entitled to purchase a resident license as long as they present military orders proving that they are stationed within the state. They must fill out a Certification of Military Active Service Status form (located in the Agent Help Link) and the license issuing agent must keep this form on file for three years. Their A DECALS file should be changed to resident to sell the license --DO NOT MARK AS MILITARY, THERE IS NO FURTHER DISCOUNT. Full-time Students are eligible to purchase resident licenses while they are attending a high school, college or university in NYS and residing in the state for the school year. The applicant must submit a current student ID card AND a current statement signed by the registrar or comparable officer of the high school, college or university that the applicant is enrolled at. Age Requirements Proof of age is required of applicants for a Senior License (70 years or older, only available for NYS residents) and for a Junior License (under 16 years of age). Proof of age may be required if it is not certain from an applicant's appearance that he/she is 16 years or older. Acceptable Proofs of Age 1) Driver's License/Learner's Permit(with a valid NYS address for senior applicants) 2) Non-Driver's ID (with a valid NYS address for senior applicants) 3) Birth Certificate (for minors) 4) Any license, certificate, or identity card issued by any governmental agency (federal, state, local, or foreign)which contains the applicant's date of birth. (i.e., passport) 5) An affidavit properly sworn and executed, subject to the penalty in Section 210.45 of the Penal Law for making a false written statement, by an applicant aged 16 years or more, or, in the case of an applicant under 16 years of age, an affidavit sworn and executed by the applicant's parent or guardian or other person over 18 years who has personal knowledge of the applicant's age. Seniors who are NYS residents become eligible for free or reduced-fee licenses at age 70. The DECALS system will recognize their age and offer the licenses at the reduced/free rate. Minors must purchase adult licenses when they reach age 16 (unless they hold a current Junior Hunting license, see below). Minors applying for a license for the first time must show proof of age and be accompanied by a parent or legal guardian with proof of guardianship. 1) Minors may fish without a license until their 16th birthday. 2) Minors may not hunt without a license at any age—Eligibility for Junior Hunting licenses begins at age 12, with appropriate Sportsman Education proof. a) Junior Hunting—age 12-15 - A Junior Hunting license includes big game tags for those ages 14 and 15. - Hunters who turn 14 during the season may apply for big game tags free of charge. b) Junior Bowhunting—age 12-15 c) Trapping—minors under 12 years old may participate in trapping activities without a license while under the supervision of a New York State licensed trapper with three years' experience who is at least 21 years old. If the experienced trapper is NOT the parent or legal guardian, a permission slip (in the Hunting&Trapping Regulations Guide)must be filled out and carried by the youth.Upon reaching age 12 and successfully completing a Trapper Education course, minors need a Junior Trapping license to trap with a mentor. Holders of a Junior Hunting license who turn 16 during the sporting license year can hold that license for the remainder of that sporting license year. There is no need to purchase a new adult license. Example, Joe is 15 and buys a Junior Hunting license on August 28. On November 1, lie turns 16. That Junior Hunting license is still good until he purchases a new license next hunting season. He may exercise all the rights of a 16-year-old as outlined in the mentor chart provided in the Hunting & Trapping Regulations Guide. Sportsman Education Requirements Fishing, Habitat Stamp, Venison Donation contributions and Conservationist Magazine purchases require no Sportsman Education. All other purchases require proof of Sportsman Education as follows: 1) Hunting—A Hunting License and a Muzzleloading Privilege requires either a Hunter Education Certificate or a previous hunting license from any state or country. 2) Trapping—Trapping or Junior Trapping licenses require either a Trapper Education Certificate or a previous trapping license from any state or country. 3) Bowhunting—Bowhunting privileges require one of the following education proofs: a) A Bowhunting License from 1980 or later from any state or country. b) A Certificate of Completion of a Bowhunter Safety Course from any state or country. Sportsman Education Course Listings are available at www.dec.ny.gov, by contacting the Sportsman Education Unit at 1-866-486-8332, or by contacting a Regional Sportsman Education Office (contact numbers are in the Hunting &Trapping Regulations Guide). A signed affidavit (see below) from any NYS License Issuing Agent that swears that a Hunting, Bowhunting or Trapping License had previously been issued to the customer may also be accepted as proof of Sportsman Education. The license issuing agent must complete the affidavit and send it to the NYSDEC License Sales Office, 625 Broadway, Albany NY 12233-4790. New York State Department of Environmental Conservation Affidavit of Previous License Please Print Legibly hereby affirm under penalty of perjury that I have previously issued a sporting license (Full Name) to while acting as a License Issuing Officer for the New York State Department (Applicant Name and Date of Birth) of Environmental Conservation from the date of: to . I may be contacted at the following telephone number if further information is required: Please select the type of license you previously issued to the applicant by selecting"YES." Select"NO" if you do not remember issuing the license type to the applicant. All license types MUST be selected. 1. Hunting YES NO 2. Bowhunting YES NO 3. Trapping YES NO HsH Date: (License Issuing Officer Signature) *Applicant Must Complete Prior to Purchase* I hereby affirm under penalty of perjury that I previously (Applicant Name) purchased a license from the party listed and that the above information is accurate. HsH Date: (Applicant Signature) *Current Issuing Officer Must Complete Upon Sale* Affidavit accepted by Agent ID Number: (Name of accepting License Issuing Officer) HsH Date: (License Issuing Officer Signature) *Issuing Agent must mail this affidavit to the address listed below within thirty(30)days of license issuance: NYSDEC License Sales 625 Broadway Albany,New York 12233-4790 This affidavit is proof of sportsman eligibility.This is NOT proof of successful completion of a Sportsman Education course. Reduced-fee Licenses Reduced-fee Licenses are available to New York State residents only. In order to qualify for these licenses, the applicant must provide the issuing agent with a valid form of NYS residency proof each year. The following Reduced-fee Licenses are available to qualified applicants: Senior Licenses are available to applicants at age 70. 1) If eligible to hunt, Senior Hunting licenses are $5. 2) Senior Fishing licenses are also $5. 3) If eligible to trap, Senior Trapping licenses are $5. 4) Seniors are eligible for Free Bowhunting and Muzzleloading Privileges when a Senior Hunting License is purchased. Seniors holding Lifetime Licenses must request the free Bowhunting and Muzzleloading privileges, which will NOT be automatically included in the Lifetime License mailing in August unless the customer also has Lifetime Bowhunting and/or Muzzleloading Privileges. Military Disabled Licenses are available to NYS resident who have been honorably discharged fi-om service in the armed forces with a 40% or greater service-connected disability. Only veterans with 40%-plus service-connected disabilities qualify; other civilian disabled people and veterans do not qualify. The applicant must submit one of the following proofs of a 40% or greater service-connected disability: 1) An annual letter from the Department of Veterans Affairs (VA) dated during the calendar year. 2) A letter written or typed on VA official letterhead and signed by an official of the VA. The letter can be from another state if the veteran entered service there. (Applicant must now be a legal resident of New York State). 3) A letter or an ID from any branch of the armed services that attests to the disability percentage and/or whether it is permanent: a) A letter of status from any branch of the armed services. b) A county Veterans Service Agency letter. c) A Certificate of Release or Discharge from the Military. NOTE: If any of the armed services IDs indicate that the applicant's disability is PERMANENT,he/she does not have to provide a letter annually and the licensing system will automatically offer the reduced-fee licenses. These individuals are eligible for reduced-fee Fishing or Hunting Licenses ($5 for the first one of those two, second one free), free Trapping Licenses, and Bowhunting and Muzzleloading Privileges,with proof of eligibility and residency. They also receive preference on DMP applications, but must pay the$10 non- refundable application fee. Free Licenses Free Licenses are available to New York State residents only. In order to qualify for these licenses, the applicant must provide the issuing agent with a valid form of New York State residency proof each year. The following Free Licenses are available to qualified applicants: 1) Active Duty Military Personnel—Under the New York State Patriot Act, resident active duty military personnel stationed outside New York State and home on leave for thirty (30) days or less are eligible for a free Fishing, Hunting and Trapping License with appropriate proof of sportsman education or previous license. Military training cannot be substituted for Sportsman Education. Acceptable proofs of residency would be New York State Driver's License or Leave and Earnings Statement (LES)that shows New York State as state of residency. The individual must also fill out the "Certification of Military Active Service Status" affidavit and agents will enter this information into DECALS and save the affidavit for three (3) years (a copy is located in the Agent Help Link). Spouses do not qualify for free licenses. 2) Active Service Militia &Reservists—Under the New York State Patriot Act, qualified members of either New York State Organized Militia or U.S. Reserve Forces may be eligible for a free Fishing, Hunting and Trapping License with appropriate proof of sportsman education or previous license. The individual must also fill out the"Certification of Military Active Service Status" affidavit and agents will enter this information into DECALS and save the affidavit for three (3) years (a copy is located in the Agent Help Link). Proof of New York State residency and military credentials (military issued ID card) are required. . 3) Native American Licenses—A member of the Shinnecock Tribe, Poospatuck Tribe, or Six Nations, residing on any reservation wholly or partly within NYS or residing in NYS eligible for free Fishing, Hunting, Trapping, Bowhunting and Muzzleloading licenses/privileges. Applicants must obtain free licenses from their Tribal Chief or Council or from the DEC License Sales Unit, 625 Broadway, Albany, NY 12233-4790. Applicants should call (518) 402-8843 for assistance. (Note: Native Americans hunting, fishing, or trapping on their reservation do not need a license). 4) Fishing License for the Legally Blind —A resident of New York State who is legally blind is eligible for a free Fishing License Only. Legally blind applicants do not qualify for free hunting licenses. 5) Fishing License for State-Funded Facilities—State-funded facilities that provide 24-hour live-in care may qualify for free fishing privileges for their residents. Exemption Eligibility Forms are available only by contacting the NYSDEC License Sales Unit, 625 Broadway, Albany, NY 12233-4790, or by calling(518) 402-8843. License Issuing Agents are not involved in this process. 6) Free Licenses for Senior Hunters and Disabled Veterans—Upon reaching age 70, hunters possessing an annual Hunting License or Lifetime License (Sportsman) qualify for free annual Bowhunting and Muzzleloading privileges with qualifying Sportsman Education. Military Servicemembers with 40% or more service-connected disabilities also qualify for these free privileges. New York State Patriot Plan What free license types will be available to qualifying military personnel? Under the Patriot Plan,the following licenses are available for free: • Hunting • Trapping • Fishing All other privileges/permits are available at regular prices. Who is eligible for free licenses? NYS residents who are active service members of the New York State Organized Militia, U.S. Reserve Forces, or certain members of the U.S. Armed Forces. "Active service"means full-time or part-time status in one of the branches of the New York and U.S. military forces listed below. Inactive service status does not qualify an individual for free DEC sporting licenses. Spouses and family members also do not qualify for the free licenses. • NY Army National Guard NY Air National Guard • NY Naval Militia • NY Guard 3 i } Note: Must be in NY National Guard, not a National Guard of another state.; � <^�r��`4 �; �p�a- k,..:�� & a?,�.�" ,#aaa" a^�€�"xi�=='i,�_� 3s:?k-"a- �-,."a^,� �a��:+;•..�}.n-�"��>,;� = .s�? CSCeOrxCGSnt e �A�«¢�-�,q;�i� � �,r,.o?,n ,3 ��, „ ?vaa� h,^'�4 "i z• ,.� ,.`.ter. ,',.���.a+;<�:�N��,�a�+-. >:4 t:. '�-. 3 ,..... . • U.S. Army Reserve • U.S.Naval Reserve • U.S. Marine Corps Reserve • U.S. Air Force Reserve • U.S. Coast Guard Reserve 3 q`ed4F&,+ves'=V,Fu`ll'=time`Active Utytj3 :At >'5x'-4o> ""�"• '''.+s'" - r'` °�'„"- m.�, J' ^.,.:»ra, .. b. �.,.^;. ,3., a:`2..a>' 3,t` • U.S.Army • U.S. Navy • U.S.Marine Corps • U.S.Air Force 1 • U.S. Coast Guard 1 Note: Must be a NYS Resident stationed outside NYS who will be in the state for no longer than 30 days for either leave or furlough. Example:NYS Resident John Doe is stationed at Camp Lejeune,NC, and will be back in the state for 20 days on leave. What forms of proof are required? 1. The"Certification of Military Active Service Status" affidavit which is available at www.dee.ny.gov and at the Agent Help Link. It must be completed by the service member seeking a free license. Agents must also enter this information into DECALS and keep the paper form for three years. AND (for fiill-time active duty U.S.Armed Forces service members) 2. Authorized leave or fiirlough orders showing applicant stationed outside of NYS and on leave or furlough for 30 days or less. AND 3. NYS residency proof. A Leave Earnings Statement (LES) from the military listing NYS as state of residence qualifies as a residency proof. To issue a license under the Patriot Plan in DECALS, select "YES" in the"military active service status" section on the "Licensee Details" page. DECALS will then recognize that the licensee is entitled to a free Hunting, Fishing and/or Trapping License with qualifying education or previous license. Agents must keep Patriot Plan affidavits on file for three years. An Environmental Conservation Officer may request to see these documents. Non-NYS residents who are active duty military and stationed in NYS are eligible for all hunting/fishing/trapping licenses, privileges and permits at the NYS Resident price. Just mark their status as "Resident" in their Customer Profile and have them fill out the "Certification of Military Active Service Status" affidavit.DO NOT MARK THE PROFILE "Military Serviceman". t Native American Licenses Native Americans can only obtain their free licenses from their local reservation, if participating, or from the NYSDEC License Sales Unit. For assistance, they should call (518) 402-8843. Native Americans fall into three possible categories of license eligibility: 1) Native Americans who wish to hunt(including bow and muzzle), fish or trap on their reservations do not need a license/privilege. 2) Native Americans residing on any reservation wholly or partly within NYS or Native Americans residing in NYS are eligible for free Fishing, Hunting, Trapping, Bowhunting and Muzzleloading licenses/privileges for use off their reservations. If fishing off the reservation all that is required is a community card. 3) Native Americans residing outside of New York State are not considered residents and must purchase non-resident licenses. Free Fishing Licenses for Legally Blind Applicants NYS residents who are blind can qualify for Free Fishing Licenses by providing either of the following documents: 1) Certification from a licensed oculist or optometrist stating the applicant's (a) central vision acuity does not exceed 20/200 in the better eye with correcting lenses, or(b)visual acuity is greater than 20/200 but is accompanied by a limitation of the field of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees. OR 2) Verification of Legal Blindness issued by the Commission for the Blind and Visually Handicapped. Free Licenses for Seniors New York State residents age 70 or older are entitled to free bowhunting and muzzleloading privileges with the appropriate Sportsman Education. In order to receive these privileges, the hunter must purchase or hold a valid hunting license, Lifetime License (Sportsman) or Lifetime Hunting (Small &Big). Once the customer reaches age 70, DECALS will automatically recognize the age and allow the customer to obtain the free privileges. In order to sell these licenses, simply select the privileges from the sales screen (you should see a zero dollar price) and complete the sale normally. Though these privileges are free, the customer must request them. They are not automatically generated. This is true also with holders of a Lifetime License (Sportsman);the customer must request them as they are an annual license and not considered a lifetime item that would automatically fill. License Exemptions Under certain circumstances, a person may hunt, fish or trap without a license. These are outlined below, but an individual should contact a DEC Environmental Conservation Officer (contact numbers are in the Hunting & Trapping Regulations Guide) in order to verify whether or not he/she is covered under the exemption. 1) Resident owners and lessees and members of their immediate families actually occupying and cultivating farm lands, may: a) Hunt wildlife other than deer, bear and turkey. b) Trap bobcat, coyote, fox, mink, muskrat, raccoon, skunk, and unprotected wildlife. c) Take fi•ogs and fish, except that they may not take bait fish by net or trap. Note: Immediate family means all persons who are related by blood, marriage or adoption to the owner/lessee and reside in that person's house. 2) Minors under the age of 16 may take fish and frogs, except they may not take bait fish by net or trap. 3) Wildlife Preserves: You do not need a NYS hunting license on any shooting preserve where a special permit has been issued. t 4) Fishing Preserves: You do not need a NYS fishing license at any body of water where a fishing permit license has been issued. Free Fishing Weekend: Each year, DEC designates the last full weekend in June, as a free fishing weekend, for residents and non-residents alike. Lifetime Licenses Lifetime Licenses are issued through DECALS and can be purchased at all license issuing agents. Lifetime License sales CANNOT be voided. If an error has occurred during the sale of a Lifetime License, please call NYSDEC Revenue Accounting at 1-800-962-5622. When issuing to a person under 12 years old, the purchaser needs to submit the child's birth certificate and parent's New York State residency proof. There will be no need for Sportsman Education until the child's 12th birthday. When issuing to a person 12 years and older, the applicant must have their proof of residency (can be their parent's proof of residency) and their proof of age. Sportsman Education proof is not required for purchase, but will need to be provided in order to have the license and associated carcass tags fulfill. Lifetime Licenses are only available to New York State Residents or former NYS Residents who had purchased a Lifetime License while a resident of NYS. Some examples follow: • If a nonresident had already purchased a Lifetime License (Sportsman) while they were a NYS resident, he/she can still purchase other lifetime privileges (Bow, Muzzle) excluding Lifetime Trapping. These individuals are also allowed to purchase annual Bow and Muzzle privileges at the resident price, but not annual Trapping licenses. • If a nonresident had already purchased a Lifetime Hunting License (Small & Big), he/she may upgrade that lifetime license to a Lifetime License (Sportsman). He/she will need to pay the difference between the current price of the Lifetime License (Sportsman) and the price paid for the original Lifetime Hunting License (Small & Big). These individuals are also allowed to purchase annual Bow & Muzzle privileges at the resident price but not annual Fishing or Trapping licenses. • If a nonresident had already purchased a Lifetime Fishing License while still a NYS resident, he/she can upgrade the license to Lifetime License (Sportsman). He/she will need to pay the difference between the current price of the Lifetime License (Sportsman) and the price they for the Lifetime Fishing License. If the individual just holds the Lifetime Fishing License, they are not eligible to purchase any other licenses/privileges at a NYS resident price. • As stated above, nonresidents who already hold a Lifetime Bow or Lifetime Muzzle Privilege can purchase annual Hunting licenses at the resident price, but there is not an upgrade path to Lifetime License (Sportsman) available. Lifetime Bow and Muzzle privileges can be purchased by nonresidents who already hold a Lifetime License (Sportsman) or Lifetime Hunting license (Small &Big). • If a nonresident already holds a Lifetime Trapping License, he/she is not allowed to upgrade this privilege or purchase any annual license/privileges at resident prices. Be sure to enter the Sportsman Education before selling a Lifetime License or the customer will have to wait up to 10 business days for the tags to come in the mail. Upon completion of a sale, give new Lifetime Licensees the Lifetime License "Congratulations Letter". There is a copy of this letter in the Agent Help Link; print it from there. Lifetime License Cards are currently being issued to all Lifetime Licensees, usually within a year of purchase. These cards are valid licenses and can be accepted by issuing agents as proof of a license for the purposes of issuing additional annual licenses and DMPs.Lifetime License Cards are not valid proof of NYS residency. Paper Lifetime Licenses are sent out by the DEC Fulfillment Center each year, and will be mailed directly to licensees by the middle of August. DEC is no longer sending out paper licenses to anyone who holds only a Lifetime Fishing or Lifetime Trapping license.Individuals who hold only Lifetime Fishing or Lifetime Trapping licenses should have received a Lifetime License card. LT Fishing/LT Trapping holders who do not have plastic card licenses yet should contact License Sales at 518-402-8843 immediately. We are in the process of sending all Lifetime License holders 16 and older a Lifetime License card. Issuing Licenses to Non-residents When issuing licenses to Non-residents, remember that there is no residency proof required but since non-residents can also access their account online, you should add their license state abbreviation and their driver's license number to their profile. Also, remember that we accept Sportsman Education Certificates and/or previous licenses (bow must be 1980 or later) from other states/countries as proof of eligibility. Non-residents are NOT eligible for age or military-disabled discounts. Revoked Licenses Revoked Licenses—The ability to buy sporting licenses may be revoked for various reasons, such as committing a violation, for a period of time determined by the Division of Law Enforcement. In these cases, DECALS will not offer the licenses that are revoked and agents will not be able to issue a particular license. The customer will have to contact DEC to determine what the problem is and how to resolve it. To alleviate any discomfort or embarrassment for agents or customers, go to"Contact DEC" in the reports dropdown and click on "Contact DEC"to print out the panel below with the phone number and instructions. J Sample of"Contact DEC" printing 3' �'„'Ba1`w "$' 8'`✓ .3 .��i^aN� H� �.° ` z e fir'.e i 1.,< a + [y'- .fi `�> Y dna {} BY•h e✓, 3't Replacing Lost Licenses Customers may replace lost licenses, back tags, big game carcass tags, and turkey permits at any licensing issuing agent for a fee of$5 for licenses and $10 for carcass tags per transaction. For example, replacing Hunting,Bowhunting, and Muzzleloading license/privileges and a turkey permit would cost$5 for the licenses and $10 for the turkey carcass tags.No one should pay more than $15 for any replacement transaction. There is never a charge to replace lost back tags or Marine Registry licenses. If you are replacing a license and tags for a Lifetime License holder who,did not receive them in the mail, you may do so with no cost to the license holder before Nov. 1. A $15 fee will show on the computer, but you will not charge the customer nor will your account be charged. After the transaction, contact Revenue Accounting at 1-800-962-5622 to have the$15 backed out of your account. If it is after Nov. I or if a Lifetime License holder loses his/her license and/or tags, charge the appropriate replacement fee. Customers who have not received licenses/tags ordered online or by phone within two weeks of the transaction are also eligible for free replacements. Follow the same procedure as with lost Lifetime licenses/tags. Reminder—When replacing any carcass tags, you must document the replacement by having the customer complete and sign the Replacement Carcass Tag Form (located in the Agent Help link).This form must be kept on file by the issuing agent for no less than three years. An Environmental Conservation Officer may ask the issuing agent to produce this document. Stolen Licenses/Tags—If a customer has their license/tags stolen and can produce a police report to substantiate their claims, there will be no charge, but you should refer them to the License Sales Unit, (518)402-8843, for the replacement. Voiding License Sales In some cases, it may be necessary to void a license. Please remember that you may only void a license on the day of sale, and that you cannot void DMPs or Lifetime License sales. If you need assistance with one of these problems, contact the Revenue Office at 1-800-962-5622. Also, voiding a license will not void the DMP selection choices. If you have an error with DMP issuance, please call the DMP Hotline at 1-866-472-4332. You must call, do not have the hunter call as we will refer them back to you to have you call us. Other Sales Habitat/Access Stamp 2013-14 Habitat/Access Stamp Design A Habitat/Access Stamp is not required to hunt, fish or trap, nor do you have to purchase a sporting license to buy a habitat stamp. Habitat is the key to fish and wildlife abundance, and the Habitat Stamp will provide money to help improve and conserve fish and wildlife habitat for the future as well as increase public access to public and private lands for fish and wildlife-related recreation. Buying a habitat stamp is the perfect way for young or old, angler or hunter, birder or r photographer, to help conserve New York's fabulous wildlife heritage. By law, all monies raised through purchases of the Habitat/Access Stamp must be deposited in the State's Conservation Fund in the Habitat Account. Habitat/Access grants are awarded for projects that improve fish and wildlife habitat and public access for hunting, fishing, trapping and other fish and wildlife related recreation. To issue a Habitat/Access Stamp, simply access the customer's profile and select Make a Donation. From there, enter the amount of Habitat/Access Stamps desired and proceed to checkout screen. The Habitat/Access Stamp costs $5.A poster of the current Habitat/Access Stamp has been provided in your Agent Packet. Venison Donation VENISON Donations to the Venison Donation Coalition may be made through DECALS. The minimum donation is $1, and there is no maximum. Voluntary contributions collected through DECALS pay for the cost of processing donated venison. You may enter this by selecting Make a Donation from the sales screen. Enter the amount of the customer's donation and complete the sale just as you would the sale of a license. Conservation Fund We are now accepting donations made directly to the Conservation Fund. You may enter this by selecting Make a Donation from the sales screen. Enter the amount of the customer's donation and complete the sale just as you would the sale of a license. f Trail Supporter Patch Donations made to this program are used for maintenance of non-motorized trails throughout NYS. The Trail Supporter Patch is $5. Enter the amount of the customer's donation in the Make a Donation sales section and complete the sale just as you would the sale of a license. Conservationist Magazine Agents can also sell subscriptions to NYSDEC's award-winning magazine through DECALS. The Conservationist may be given as a gift without creating a new profile, by putting the recipient's address in the new window that opens when you click that it's a gift. Sportsmen with Disabilities (Special Licenses) Sportsmen with disabilities are not eligible for reduced fee or free licenses unless their disability is service-related. However, there are two special permits for sportsmen with disabilities. These permits are available by contacting the NYSDEC Special License Unit, 625 Broadway, Albany, NY 12233-4752, (518) 402-8985. Non-Ambulatory Permit—allows a non-ambulatory hunter to possess and use a loaded firearm in a parked motor vehicle. 1) Applicant must submit a completed Non-Ambulatory Hunter Permit Application, containing a physician's signature attesting that the applicant relies upon a wheelchair or similar mechanical device to move about. 2) Applicant must possess a valid NYS Hunting License. 3) There is a$5 fee for the permit. 4) Applicant must provide two 2"x 2" photos that will be used for a Non- Ambulatory Hunter Permit ID card. Modified Longbow Authorization—Allows qualified sportsmen to hunt small and big game with a bow that is equipped with a mechanical device to hold it in a drawn and cocked position. 1) Applicant must be permanently or temporarily disabled and unable to draw and hold a bow, and must possess a standard department form signed by a physician verifying that he/she meets the qualifications established by law. The Modified Archery permit is available at www.dec.ny.gov/permits/25018.htmi. If you have questions, please contact the Special Licenses Unit at(518) 402-8985. 2) There is no fee for this permit. Questions about these permits or requests for permit applications should be directed to: NYSDEC Special Licenses Unit, (518) 402-8985. Deer Management Permits (DMPs) Deer Management Permits (formerly known as doe or party permits) are used by DEC as a management tool to control deer populations by allowing hunters to harvest controlled numbers of antlerless deer throughout New York State. DMPs are issued by Wildlife Management Unit (WMU)through DECALS in an Instant Lottery process that begins the first day of hunting license sales and concludes on October 1. DMPs are also available through a back-end selection (IBP) after the close of the Instant Lottery, and during a First-Come/First-Served period beginning November 1. A customer must purchase or possess a hunting license in order to apply for a DMP. There is a $10 non-refundable application fee for DMP applicants, except those who hold a Lifetime License (Sportsman) purchased prior to October 1, 2009, and holders of resident and non- resident Junior Hunting and Junior Bowhunting licenses. An applicant may apply for up to two DMPs. Both permits must be applied for at the same time. The permits may be in the same or different WMUs. During the Instant Lottery, probabilities of selection by WMU are predetermined and entered into the DECALS system prior to licenses going on sale. A hunter's chances of receiving a DMP in each WMU are listed on the DEC website (www.dec.ny.gov/outdoor/6403.htm1#Order) and on a poster provided to each License Issuing Agent before the hunting license sales season. The WMU probabilities remain unchanged throughout the application period. A hunter's chances of receiving a DMP are the same on the first day of license sales as they are on October 1. This is not a first-come/first-served process. For information about DMP, call the DMP Hotline, 1- 866-472-4332. An applicant's chances of selection in each WMU are determined by the selection category an applicant falls in. The categories, in priority order, are as follows: 1) Landowners and Disabled Veterans (see descriptions below) 2) NYS Residents with Preference Points 3) NYS Residents without Preference Points 4) Non-residents with Preference Points 5) Non-residents without Preference Points Currently, most applicants with three or more Preference Points prior to the selection will receive their first choice WMU. This may change in the future to accommodate deer management goals, and three preference points may not guarantee selection. Agents will be notified if there is a change in the selection policy for a particular WMU. Since an applicant's chances of receiving a DMP are determined by the categories listed above, it is important for License Issuing Agents to capture the data which will determine these categories. While entering information on the Licensee Detail Screen, remember to ask your customer if he/she will be applying for a DMP as either a Landowner or a Disabled Veteran. If so, proceed as follows: 1) Landowners—To qualify as a landowner, an applicant must own 50 or more contiguous acres in the WMU where he/she will be applying for a first-choice DMP. The customer must provide both the SWIS Code and Tax Map Identification Number for their property; these numbers are on their property tax bill. You do not have to see the tax bill; however, the applicant must supply the information from it. 2) The WMU that the landowner is applying for must be offering DMPs for the current year. 3) A spouse of a landowner may apply for a DMP, but both husband and wife may not apply for a landowner preference for the same parcel of land. 4) Corporate Landowners: Only one person can be designated by a corporation as the landowner each year, no matter how many 50-acre parcels are owned. The corporation must submit an original letter or certified copy of a resolution designating the individual who has been chosen to apply as the landowner, and including the tax map identification number. 5) Disabled Veterans—To qualify as a Disabled Veteran, a customer must have a service-connected disability rated at 40% or greater and be a resident of New York State. If the disability is not permanent, the customer must annually show a letter from Veterans Affairs, dated in the current year, which lists his or her disability of 40% or greater. Agents must enter the case number from this letter into the "Annual Disability" section of the Licensee Detail Screen. If the customer's disability is listed as permanent,the case number should be entered in the"Permanent 40%+Military Disabled Case Number" field on the detail screen. Preference Points—If a customer has Preference Points from a previous year, they will be listed on the Licensee Details Screen next to the field labeled "Preference Points". It is important to locate the customer's existing file in DECALS, so that the points are applied to the DMP selection. NEVER create a new file if the customer already has one. If you have trouble locating a customer in DECALS, call the DMP Hotline at 1-866-472-4332. If you make an error in issuing a DMP (e.g., issued wrong unit, forgot to enter customer's second choice, etc.), corrections can only be made by DEC staff. Call the DMP Hotline at 1- 866-472-4332 and our staff will make the correction and mail the DMP to the customer. The issuing agent should keep the erroneously issued DMP and send it back with Returnable Documents along with a note explaining the error. DMPs cannot be voided by agents. Do not attempt to void the big game license to correct a DMP error, as the big game license will be removed, but the DMP will remain in the customer's holdings. Only DEC staff can correct or void DMPs. Voiding the entire sale will not remove the DMP from the customer's holdings. Intermediate Batch Process (IBP)—After the close of the Instant Lottery and prior to the First- Come/First-Served application period,DEC may choose to run an Intermediate Batch Process to issue leftover DMPs. The IBP is a back-end selection process used to issue DMPs to customers who were initially denied their first and/or second choices during the Instant Lottery in WMUs that were under-subscribed.DEC will conduct the IBP and mail the permits to some previously denied customers prior to the sale of First-Come/First-Served DMPs. Customers will neither gain nor lose Preference Points during the IBP. License Issuing Agents are not involved in this selection process. If a customer inquires about whether or not he/she received a DMP through the IBP, you may go to his/her Licensee Detail Screen and view the DMP History. Please make sure that you verify licensee addresses annually and update both the residence and mailing address when. This will ensure that if the licensee is selected for a DMP through the Intermediate Batch Process, their permits will reach them. First-Come/First-Served (FCFS)DMPs—If there are permits remaining after the Instant Lottery and IBP selection processes are completed,the remaining DMPs will be available at all License Issuing Agents on a first-come/first-served basis beginning on November 1. The WMUs with permits will be announced via news release and sent to all License Issuing Agents via Agent Messaging. There is no hierarchy or preference given to customers during the FCFS application period. WMUs available in the morning will continue to be available until close of business on the same day. As the WMUs fill, the list of available units will change on a daily basis. You may wish to post available WMUs every morning for your customers to view, and a list of available WMUs will appear after clicking "DMP Application" on the Sales screen, so you will know if the WMU is available before proceeding with the sale. If the customer already applied for a DMP during the Instant Lottery, there is no additional fee for the FCFS permits. If he/she is applying for the first time, the fees are the same as the Instant Lottery. Up to two DMPs may be issued during FCFS (both must be issued at the same time). If you have questions about problems with DMP issuance, call the DMP Hotline at 1-866- 472-4332. T Neville, Elizabeth From: Neville, Elizabeth Sent: Friday,April 30, 202111:51 AM To: 'supervisor.license@dec.ny.gov' Cc: Rudder, Lynda; Born, Sabrina; Doroski, Bonnie; Mudd,Jennifer;Jobes, Craig; Foote, Nancy Subject: Town of Southold Agent ID#2059 Attachments: NYS DEC License Issuing_20210430113002.pdf Importance: High Good Morning, Six(6) months have passed since my initial attempt to renew my"Licensing Issuing Agent Agreement" and change my Assistant License Issuing Agent from Carol Hydell (as she has longer works in my office)to my Deputy Town Clerk Lynda M. Rudder. Many attempts have been made since,all unsuccessful. As a result we are not able to issue any NYS DEC Conservation Hunting or Fishing Licenses in this office. In speaking with Vendor support 347 227-0452 this morning, I was told that we still do not have a connection to the new licensing issuing system. The above attachment contains the signed agreement,Southold Town Board Resolution no. 2020-703 and all related forms and documents which were mailed to you by Certified Mail on October2l, 2020 and received by you on October 26, 2020 as indicated by your NYSDEC Stamp. I would like an explanation of why the NYS DEC has not corrected this situation. Elizabeth A.Neville Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631765-6145 Cell 631466-6064 1 1 s UNITED STATES POSTAL 5Y1 VICE. SOUTHOLD 710 TRAVELER ST SOUTHOLD, NY 11971-1000 (800)275-8777 10/21/2020 04:58 PM 1 11 -------------- -------------- Prr�oduct Oty Unit Pricr Price --g---------=----------------------------- Prtpaid Mail! 1 $0.00 1Weight: b ,l'b 3.10 oz J C Acceptance Date: ,Wed 10;21/2020 Tracking=#: 70141200000167435094 ---------------------- Grand Total : $0.00 J ••J ' ;PrVi ew your Mail Track your Packages �� - Sign up for FREE ® Postal www.informeddeli,Very.com CERTIFIED MAILT. RECEIPT All sales final on stamps and postage. (Domestic MaH Oniy,No Insurance Coverage • . Er Refunds for guaranteed services only. a . Thank you for your business. to ' Tell us about r experience. 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InsuierJ°Mail f]°SlgriatureQGnotiatiD!s:.i Insured Ma l Restricted Delve Restricted Re2ryery,.,r ! 7014 1200 0001 6743 5094 '(over$S00) Delivery k PS'Form 3811.JU-1v 2015 PS141530-02-000-9053 • DomestWc au'fm, elpt TOWN OF SOUTHOIL : z ELIZABETH A.NEVILLF TOWN CLERK P.O.BOX 1179 SOUTHOLD,NEW YORK 11971 „ Revenue &Accounting Unit ; NYS Dept of Environmental Conservation 625 'Broadway, 10th Floor Albany, New York 12233-4900 ; RESOLUTION 2020-703 ADOPTED DOC ID: 16509 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2020-703 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 20,2020: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Town Clerk Elizabeth A. Neville to execute a License Issuing Agent agreement with the New York State Department of Environmental Conservation in connection with the issuance of hunting and fishing licenses, all in accordance with the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Jill Doherty, Councilwoman AYES: Nappa, Dinizio Jr, Doherty, Ghosio, Evans, Russell NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION LICENSE ISSUING AGENT AGREEMENT (Do not alter this Agreement. If information is incorrect, please call the New York State Department of Environmental Conservation at 518-402-9365.) This Agreement entered into between the New York State Department of Environmental Conservation (hereinafter referred to as the "Department"), with offices at 625 Broadway, Albany,New York 12233, and Elizabeth A. Neville Name as the Downer Elmunicipal clerk ❑manager of ToTim of Southold53095 Main Road, P.G.B©X 1179 Business/Municipality Name Street Address Southold New York 11971 City/Town/Village State Zip Code (hereinafter collectively referred to as the "License Issuing Agent") WITNESSETH: WHEREAS,the Department is authorized by§ 11-0713 of the Environmental Conservation Law and applicable rules and regulations to appoint agents to issue licenses for the privilege of hunting, fishing and trapping in New York State; and WHEREAS,the License Issuing Agent has applied to the Department for appointment as such a License Issuing Agent; and WHEREAS, the Department has determined that the above License Issuing Agent applicant is qualified to be appointed as a license issuing agent. NOW THEREFORE, the parties hereto agree as follows: 1. DEFINITIONS As used in this Agreement, the following terms shall have the meaning provided herein: License Issuing Agent—shall mean both the License Issuing Agent and the License Issuing Officer as provided in 6 NYCRR § 177.1(f) and (g) of the Department regulations and shall also mean the duly appointed owner, municipal clerk, or manager set forth above. Assistant License Issuing Agent—shall mean the individual appointed by the Licensing Issuing Agent to receive Department-sponsored training for the purpose of issuing sporting licenses and to be the point of contact for any Department inquires. Approved location—shall mean the business' or municipality's address as set forth in the beginning of this Agreement. Page 1 of 10 2. APPOINTMENT A. The Department hereby appoints the License Issuing Agent and their duly appointed Assistant License Issuing Agent(designated below)to be an agent issuing hunting,trapping, and fishing licenses at the approved location. B. The License Issuing Agent hereby appoints 7,ynda M_ Rudder , Name Deputy To= Clerk , as the Assistant License Issuing Agent. Title (See paragraph [11.F] herein for information regarding changes in appointment of the Assistant License Issuing Agent.) 3. DEPARTMENT REPRESENTATIONS The Department hereby agrees that it will: A. Provide the License Issuing Agent with a license printer(and necessary supplies) at the approved location for the sale and reporting of hunting, fishing and trapping licenses and provide necessary support for the printer. B. Pay a commission to the License Issuing Agent for each license sold as prescribed in Department laws, rules and regulations. C. Provide appropriate training and training materials to the Assistant License Issuing Agent, including a toll-free telephone "help desk" service to answer questions and assist with problems. D. Provide informational materials for use at the approved location for the License Issuing Agent and their authorized employees to distribute to hunters, anglers, trappers, etc., regarding regulatory requirements for all authorized licenses issued. 4. AGENT REPRESEN T A T 10NS The Agent hereby agrees that it will: A. Provide authorization attached hereto as Attachment"A"for the Department to access a bank account for electronic fund transfers to pay for all licenses sold. Fund transfers shall be scheduled on a regular basis as determined by the Department. B. Provide reasonable and necessary security to protect equipment and supplies from damage and unauthorized use. C. Ensure that all Department license issuing equipment is maintained in good working condition and returned to the Department when license sales are no longer provided at the approved location. Page 2 of 10 D. Pay all amounts due to the Department. Failure to maintain an adequate balance in the License Issuing Agent's account may result in immediate termination of this Agreement. E. Provide a compatible computer system including a plain paper printer and access to the internet at no charge to the Department. F. Indemnify and save harmless the Department and the State of New York from and against all losses from claims, demands,payments, suits, actions, recoveries and judgments of every nature and description brought or recovered against it in a court of competent jurisdiction, to the extent such loss is attributable to a negligent omission or tortious act of the License Issuing Agent, its agents or employees, in the performance of this Agreement. G. Be solely responsible for the supervision and direction of the performance of this Agreement by the Assistant License Issuing Agent and other authorized license issuing employees other than as specifically provided herein. H. Alert the Department if the License Issuing Agent, Assistant License Issuing Agent or other person issuing licenses is convicted of a misdemeanor or felony level criminal offense. I. Not allow a person convicted of a misdemeanor or felony level criminal offense to issue licenses or have access to the license system, unless the person's conviction has been reviewed by DEC. 5. AGENT RESPONSIBILITY A. General Responsibility: The License Issuing Agent shall at all times during the Agreement term remain responsible. The License Issuing Agent agrees, if requested by the Commissioner or his or her designee,to present evidence of its continuing legal authority to do business in New York State, integrity, experience, ability,prior performance, and organizational and financial capacity. B. Suspension of Work (for Non-Responsibility): The Commissioner or his or her designee, in his or her sole discretion, reserves the right to suspend any or all activities under this Agreement, at any time, when he or she discovers information that calls into question the , responsibility of the License Issuing Agent. In the event of such suspension,the License Issuing Agent will be given written notice outlining the particulars of such suspension. Upon issuance of such notice,the License Issuing Agent must comply with the terms of the suspension order. Agreement activity may resume at such time as the Commissioner or his or her designee issues a written notice authorizing a resumption of performance under the Agreement. 6. LICENSE ISSUING CONDITIONS A. All licenses authorized to be sold pursuant to this Agreement may only be sold by the License Issuing Agent, the Assistant License Issuing Agent or authorized employees of the License Issuing Agent at the approved location set forth in this Agreement. B. All employees authorized to issue licenses by the License Issuing Agent pursuant to paragraph "A" of this section, shall be appropriately trained in the use of the license issuing system by the Assistant License Issuing Agent prior to using the issuance system. Page 3 of 10 C. The Assistant License Issuing Agent must receive recurring training sponsored by the Department at least once every three years or sooner as circumstances warrant as determined by the Department. D. The License Issuing Agent and his/her employees who are authorized to issue licenses pursuant to this Agreement must abide by New York State Regulations 6 NYCRR Part 177 (=.dee.ny.gov/regs/3936.html and 6 NYCRR Part 183 (=.dec.ny.gov/regs/393 I.html). E. All personal data provided by customers shall be kept confidential to the extent required by Law. F. All documents considered returnable documents as well as all voided licenses for which credit is requested must be returned to the Department within one month of the transaction. G. All funds received from the sale of licenses, less the commission fee established by the Department, will be held in trust for the Department. Monies collected from the sale of licenses are Department funds and any other use of such funds is prohibited. The License Issuing Agent accepts the responsibility and duties of trustee for all funds collected for the benefit of the Department under this Agreement. H. No license may be sold for a fee in excess of or less than the amount established by the Department. I. The complete catalog of sporting licenses must be available for sale to the public at the License Issuing Agent's approved location as designated in this Agreement. 7. USE OF EQUIPMENT AND SUPPLIES A. Supplies and equipment assigned to the License Issuing Agent for the printing of licenses are to be used for that purpose only, unless prior approval for such use is provided by the Department. Equipment is not transferable to other license issuing agent locations. B. In the event that defective equipment is replaced, the License Issuing Agent shall return the defective equipment immediately to the specified repair center. The License Issuing Agent shall pay for any such equipment not returned, or equipment that shows obvious abuse. Failure to remit payment for abused or unreturned equipment may result in the immediate termination of this Agreement. 8. CHANGE IN OWNERSHIP In the event of a change in ownership of the License Issuing Agent's business, the Department must be notified 30 days in advance of any such change, and this Agreement becomes immediately terminated at the time of such change in ownership. At the time of termination, all Department-provided licensing equipment must be returned to the Department or the Department's representative. This License Issuing Agent's appointment is not transferable and shall apply only to the License Issuing Agent's appointment to sell sporting licenses. Page 4 of 10 9. CHANGE IN MUNICIPAL CLERK In the event of a change in municipal clerk from that who entered into this Agreement,the Department must be notified within 30 days of such change and this Agreement will become void at the time of such change. To avoid a disruption in service, a new Agreement should be submitted in advance of such change signed by the new municipal clerk. If the municipality intends to submit a new Agreement, Department-provided equipment does not need to be returned. 10. COMPLIANCE INSPECTIONS The Department reserves the right to inspect the approved location for the purpose of determining compliance with this Agreement. 11. TERMINATION In addition to any termination event appearing elsewhere in this Agreement, or provided in the applicable Department regulations, the following shall apply: A. This Agreement may be terminated for cause if the Department determines that any false statements or omissions were made on the License Issuing Agent's application. B. This Agreement may be terminated for cause for failure to comply with the terms of this Agreement at any or all approved locations at any time by the Department. C. Either party may terminate this Agreement for convenience by 15 days written notice to the other party. D. In the event of termination of this Agreement, the License Issuing Agent shall pay for all licenses sold and not previously paid for and return all equipment and supplies to the Department within 30 days of such termination. E. Termination for Non-Responsibility: Upon written notice to the License Issuing Agent, and a reasonable opportunity to be heard with appropriate Department officials or staff the Agreement may be terminated by the Commissioner or his or her designee at the License Issuing Agent's expense where the License Issuing Agent is determined by the Commissioner or his or her designee to be non-responsible. In such event, the Commissioner or his or her designee may complete the contractual requirements in any manner he or she may deem advisable and pursue available legal or equitable remedies for breach. F. In the event of a change in the appointment of the Assistant License Issuing Agent, the License Issuing Agent shall notify the Department of such change within 15 business days by submitting to the Department a completed revised License Issuing Agent Application Form attached hereto as Attachment`B,"which shall provide, among other things,the name and title of the newly appointed Assistant Licensing Issuing Agent. In the Department's sole discretion, this agreement may be suspended or terminated in the event the Department is not notified of any change in appointment of the Assistant License Issuing Agent as provided herein. Page 5 of 10 12. TERM This Agreement shall remain in effect from the date of execution until such termination. 13. APPLICABLE LAWS A. This Agreement shall be governed by the laws of the State of New York. B. All licenses shall be issued in accordance with the provisions of the New York Codes, Rules and Regulations of the State of New York(htti)://www.dec.nY.Rov/regs/2494.htmi) and New York State Law and the policies and procedures of the Department. 14. TOTAL AGREEMENT This Agreement together with any laws, documents and instruments herein referenced, shall' constitute the entire agreement and any previous communication pertaining to this Agreement is hereby superseded. - 15. - CONTRACT AMENDMENT Any agreement revisions, including payment adjustments or time extensions, shall be made by a written amendment to the agreement, signed by both parties. Signature g AgA RAA . Date: 10,116.17020 Lic se Issuing Agent (nota zation required below) LICENSE ISSUING AGENT ACKNOWLEDGMENT State of New York ) )s.s.: County of Suffolk ) On the 16th day of October ,in the year202O before me,the undersigned,personally appeared Elizabeth A. Neville personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies),and that by his/her/their signature(s)on the instrument,the individual(s),or the person upon behalf of which the individual(s)acted,executed the instrument. DR,- as ,a0aa Date Notary.Expires Notary Public SABRINA M BORN Notary Public,State of New York No.01806317038,Suffolk Coun Commission Expires Dec.22,20, Page 6 of 10 Signature Date: DEC Representative NOTE: A faxed copy of this agreement and the associated application will not be accepted. Completed applications and agreements in their original form should be mailed to: Attn: Revenue and Accounting Unit New York State Department of Environmental Conservation 625 Broadway, 10th Floor Albany,New York 12233-4900 Page 7 of 10 Attachment A New York State Department of Environmental Conservation Division of Management& Budget Services Bureau of Revenue Management-10'h Floor 625 Broadway,Albany,New York 12233-5012 Phone:(518)402-9365 • FAX: (518)402-9356 Website:www.dec.state.ny.us Please complete, review and sign this form. Attach a voided check or a statement from your bank that includes the routing number and account number for the account from which the ACH debits will be drawn and mail this items to the address above. New York State Department of Environmental Conservation Authorization Agreement for Direct Payments(ACH Debits)relative to the Department's automated sporting license system. Agent/Officer Name: Elizabeth A. Neville Business Address: 53095 l�iain Road, PO Box 1179 City: Southold State: New York ZIP: 11971 Telephone: 631 765-1800 I hereby authorize the New York State Department of Environmental Conservation,hereinafter called DEPARTMENT,to initiate debit entries to my account indicated below at the financial institution named below,hereinafter called DEPOSITORY,and to debit the same account.I acknowledge that the origination of ACH Transactions to my account must comply with the provisions of U.S.law. Branch Name: B ri g hQ a cin hi n t;onal Bank Address: 54970 Main Road City: Southold State: New Mork ZIP Code: 11971 Contact: Linda Carlson Telephone: 631 7651500 Routing Number: 021406667 Account Number: 0500027685 Account Name Torn Clerk o Conservation Licenses Account Type: [�q Checking[ ] Savings [j This authorization is to remain in full force and effect until DEPARTMENT has received written notification from me of its termination in such manner as to afford DEPARTMENT and DEPOSITORY a reasonable opportunity to act on it. Signature: a Date: 1> NOTE: ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION. Page 8 of 10 ins ar .,4 %44 ;no Am ky.Z41 onq Q Q q -w an.0 nQ a R Nbzc�_ww w All j.,4; Kf , t,A'" tel 0 &p5joh 4--h.-, q WIFE Ty X"i 0 _Wl Atf Iv, EWA== Z N BHB IqKxl BwO 7" r ;lou Ric)ca A vmmw �_T_&_PNE ........... i.RECORD ALL CHARGES OR CREDITS THAT LYOUR"ACCOUN V Y DESCRIPTION OF TRANSACTION PAYMENT/DEBIT CREOrf, NUMBER $o ---------- ...... ...... ffs, h still IS YRft ...................- A +..Wm�t4 a=r"-.r, .. ......... AT u_ u ice "mn A �kr -No f m m Ali _J 10 ­u� gof AM% HIM 1100PI 4, NAnO 70 MAIN ROAD BANK $O HOLD,NY-181 mwo go.0 2 1,406��6 05-02768- 51" 90TT:I'-- IDEN KE m ___4 S 7 '5,T-P 4, 1 Not V� n� REM 7 4:0 -rp- jQ! 'Al 41 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION LICENSE ISSUING AGENT APPLICATION _ ATTACHMENT "B" = LICENSE ISSUING AGENT PERSONAL INFORMATION FIRST,MIDDLE INITIAL,LAST NAME: Elizabeth A. Neville DOB'07/27/1947 HOME ADDRESS: 110 Sleepy hollow Lane STREET/PO BOX: P-0- Rnx 99q CITY:, Southold STATE: New York ZIP CODE: 11971 HOME TELEPHONE NUMBER: 631 765-2054 WORK TELEPHONE NUMBER: 631 765-1800 HAS APPLICANT SOLD NEW YORK STATE HUNTING AND FISHING LICENSES PREVIOUSLY?A YES ❑NO IF YES,PLEASE PROVIDE AGENT NUMBER: 5211 ARE THERE ANY OUTSTANDING LIENS AGAINST OR JUDGMENTS IN THE NAME OF THE APPLICANT?❑YES D] NO- HAVE YOU BEEN CONVICTED OF A MISDEMEANOR OR FELONY LEVEL CRIMINAL OFFENSE?* ❑ YES ® NO IF YOU HAVE ANSWERED"YES",PLEASE PROVIDE THE FOLLOWING: i. Certificate of Disposition or similar document if the conviction occurred in another state, ii. A signed and dated statement describing the conviction(s),including sufficient detail of events leading up to the conviction and any post-conviction rehabilitation and good conduct; iii. One or more letters of recommendation from someone other than a relative and any additional documentation relevant to review of the application,such as a certificate of relief from disability and documentation showing personal accomplishments since the conviction(s),including professional licenses,rehabilitation documents,courses or degrees. *Note:A response of yes to the above question is not an absolute bar to serving as a license issuing agent or assistant license issuing agent. IS THE APPLICANT 18 YEARS OF AGE OR OLDER?JVYES nk' NO BUSINESS INFORMATION LEGAL NAME OF BUSINESS OR MUNICIPALITY: Town of Southold FEDERAL EMPLOYER IDENTIFICATION NUMBER: 11-6001939 TYPE OF BUSINESS: (M GOVERNMENT ❑ SOLE PROPRIETORSHIP❑ CORPORATION ❑PARTNERSHIP ❑ LIMITED PARTNERSHIP BUSINESS MAILING ADDRESS: 53095 N;ain Road STREET/PO BOX: P.O. Bog 1179 CITY: Southold STATE: New York ZIP CODE: 11971 BUSINESS SHIPPING ADDRESS(If Different From Above) STREET ADDRESS CITY STATE: ZIP CODE: BUSINESS TELEPHONE NUMBER: 631 765-1500 BUSINESS FAX NUMBER: 631 765-6145 BUSINESS E-MAIL ADDRESS: e.neville town.southold.n ous HAS THIS BUSINESS LOCATION SOLD NEW YORK STATE HUNTING AND FISHING LICENSES PREVIOUSLY? l$I YES ❑ NO IF YES,PLEASE PROVIDE AGENT NUMBER: 2059 Page 9 of 10 BUSINESS OPERATIONS DAYS/HOURS OF OPERATION DAY OF WEEK OPENING TIME CLOSING TIME SUNDAY Closed _AM _PM AM PM MONDAY 8.00 AN 4:00PY1 TUESDAY 4:OOPH WEDNESDAY AM 4:00PX THURSDAY 8.-00 Ala 4,.00PM FRIDAY 8.00 AN 4 m 00PM SATURDAY Closed IS THIS BUSINESS OPEN YEAR AROUND?)Q YES ❑ NO IF NO,STATE MONTHS OF OPERATION: ASSISTANT LICENSE ISSUING AGENT INFORMATION (To be appointed by the License Issuing Agent listed above) FIRST,MIDDLE INITIAL,LAST NAME:L da 14. Rudder DOB02/24/197&; HOME ADDRESS: 625 Victoria, Drive STREET/PO BOX: CITY: Southold STATE: Rew York ZIP CODE: 11971 HOME TELEPHONE NUMBER: 631 7963256 WORK TELEPHONE NUMBER: 63Lt 7<65®1800 HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY LEVEL CRINIMAL OFFENSE?* ❑ YES ® NO IF YOU HAVE ANSWERED"YES",PLEASE PROVIDE THE FOLLOWING: i. Certificate of Disposition or similar document if the conviction occurred in another state, ii. A signed and dated statement describing the conviction(s),including sufficient detail of events leading up to the conviction and any post- conviction rehabilitation and good conduct; iii One or more letters of recommendation from someone other than a relative and any additional documentation relevant to review of the application,such as a certificate of relief from disability and documentation showing personal accomplishments since the conviction(s), including professional licenses,rehabilitation documents,courses or degrees *Note:A response of yes to the above question is not an absolute bar to serving as a license issuing agent or assistant license issuing agent. IS THE ASSISTANT AGENT 18 YEARS OF AGE OR OLDER? K1 YES ❑NO License Issuing Agent Applicant Certification and Signature: The undersigned recognizes that this application is submitted for the express purpose of inducing the State ofNew York,through the Department,to appoint me as a license issuing agent with the authority to issue hunting,trapping,and fishing privileges in the State ofNew York;acknowledges that the State or the Department may,by means which it may choose,determine the truth and accuracy of all statements made herein;acknowledges that intentional submission of false or misleading information may constitute a felony or misdemeanor under Penal Law§210;and states that the information submitted in this application and any attached pages is true,accurate and complete Signed: QY1Dated:m-li film2a i ense Issuing Agent Page 10 of 10 Neville, Elizabeth From: dec.sm.Supervisor.License <Supervisor.License@dec ny.gov> Sent: Friday, October 16, 2020 1:38 PM To: Jobes, Craig Cc: Rudder, Lynda; Foote, Nancy; Neville, Elizabeth Subject: Re: New Agent of Record Attachments: LIA Agreement V46 .pdf Sorry for the delay, we have had a huge influx of these requests due to agents letting us know about AOR changes more recently instead of when they occurred (this may or may not be your particular situation but it has created a back log). This change cannot be done just by email us. We need a new agent agreement (attached)completed and sent back to the address listed in the agreement itself. Once Revenue receives and reviews that agreement they will let me know so we can move forward. Unfortunately, this will not be a quick process. We will move thing forward as fast as we can while we are in our busy season, working with less staff and working through a new license issuing system. Thanks, Kevin Maloney NYS DEC License Sales From:Jobes, Craig<craigi@southoldtownny.gov> Sent:Thursday,September 3, 2020 9:28 AM To: dec.sm.Supervisor.License <Supervisor.License@dec.ny.gov> Cc: Rudder, Lynda <lynda.rudder@town.southold.ny.us>; Foote, Nancy<nancy.foote@town.southold.ny.us>; e.neville@town.southold.ny.us<e.nevilie@town.southold.ny.us> Subject: New Agent of Record „i?l_�x+d� ,,.ysl" _v`':��s"�•. ,,i,5'�i'" .pry :: ;�.""sr, � ;,r."-i..; .i..��,�'�F'..'r �`�'� fr��: .,'3s f�.,• �s`2" ,�, i�«,�'�?.�� �, ��.. ,...:�� vxa'-,. .�?wt`4�r_,. �¢ w,t.. ','�s*�.,'w'' c�*^.•.a, .......,.._...�...,.�.........�_.a=. `r'�s<� ^kst. �' 4°:cfia'ri. �': ,a,,,`,�,r�.a`'' � 9,�`F�;iz= r•,:�� I D#2059 Old: Carol Hydell New: LYNDA RUDDER This is the second attempt to have this changed. Please make the appropriate changes ASAP so that we can begin printing and issuing licenses. 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Service Type ❑Prionty Mail Expresso I1��III�I I II lil�ll�I II��II II II I I'l l III I��I� 1.3 ❑Adult Signature ❑Registered MaI I ❑Adult Signature Restricted Delivery Registered Mailil Restricfedl f I Certified Mail@ Delivery I 9590 9402 5230 9122 2783 75 Certified Mad Restricted Delivery Return Receipt for I I` ❑Collect on Delivery er=dise ❑ ollect on Dehv-ery Restricted Delivery ❑Signature ConfirmationTR' Number_[fr2tts/el_from-service,label)�•-- - LO-Insured Mail ❑Signature Confirmation-- --a s� —^ —�—•••s 7 014 12 0 0 0 01 67 4-3 50 9 4 —--n-i(nve Mad-Restn�ted.D�'��r Restricted Delivery-_ — over$500) I i 4 r Domestic Return Receipt t I PS Form 3$11,July 2015 PSN 7530-02-D00-9053 _ I I ' I I • 'I I - I I bL 1 ► xo� •p� "'l) 'n"'N H P9'0z!r3 I '"'AJOS 1e;Sod I /xoq sly;w®y+dlZ pue'ssaJppe'ewt:u.lnofluud ast:ald:JapuaS. 53�1'jS p6mun i I I 54 EQL2 22% DE25 20fi6 0656 i OVE)'DN tlwJed I SdS(1 Red seed v"i I WIN ssel-)-tsll:j I d #`JNNOV2u SdSfl J 5 T RESOLUTION 2013-834 g �o ADOPTED DOC ID: 9289 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2013-834 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 19,2013- RESOLVE D 9,2013:RESOLVED that the Town Board of the,Town of Southold hereby authorizes and directs Town y Clerk Elizabeth A. Neville to execute a License Issuing Agent agreement with the New York State Department of Environmental Conservation in connection with the issuance of hunting and fishing licenses, all in accordance with the approval of the Town Attorney. 0"a 2�� Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER:Christopher Talbot, Councilman AYES: Dinizio Jr, Ruland, Doherty, Talbot, Evans, Russell FF04�o ELIZABETH A.NFVEL LE,MMC �.1► Gy Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 H Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(631)765-6145 MARRIAGE OFFICEROl ��pt' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 10, 2013 GAME MANAGEMENT NYDS DEC 625 Broadway Albany, NY 12214-0334 Dear Sirs: Enclosed, please find my signed"license Issuing Agent Agreement"for approval and signature. Please return a fully executed copy tome for my records. Thank you, Very truly yours, Eliza eth"ANeVialle4VZ�& Southold Town Clerk Enclosure(1) EAN NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Fish, Wildlife & Marine Resources License & Promotional Sales 625 Broadway, 15t Floor, Albany, New York 12233-4790 Phone: (518)402-8843 • Fax: (518)473-2105 Website: www.dec.ny.gov Joe Martens Commissioner September 30, 2013 Dear License Sales Agent: Just to clarify some enhancements in your Agent Agreement which is enclosed. There was concern that the Agent of Record would not always be the actual person doing the selling. We have addressed that in the new agreement. In Section 2 - Appointment, you now have the option to identify someone to be trained and therefore would be able to sell and train other clerks under your agent number. Alternatively, you may have the same name in both the License Issuing Agent and the Assistant License Issuing Agent. This enhancement will assist Town Clerks so they can appoint their deputy while still being the Agent of Record. It will also be appropriate for our large retail store Agents to be able to allow a designated clerk to do the selling to attend training and then train others in their department. The person identified will be the contact for our Revenue Office. Please remember that with any personnel changes at your establishment, either someone being transferred from one store to another for retail Agents or changes within the municipalities, a new Agent Agreement must be submitted to our Revenue Department. The new Agent Agreement out lines this in detail under Section 11 - Termination subsection F. If you do not notify Revenue of your changes, the Agent of Record on file will- be held accountable for any discrepancies. Additionally, please remember that we are limited to only one License Issuing Agent or Assistant License Issuing Agent participating in the hands-on training from each agent location. Please make sure you return your Agent Agreement in the postage paid envelope no later than December 15, 2013. Sincerely, Donna Kalled Project Specialist Enc. Agent Agreement Training Invitation NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION LICENSE ISSUING AGENT AGREEMENT (Do not alter this Agreement.If information is incorrect,please call the New York State Department of Environmental Conservation at 518-402-9365.) This Agreement entered into between the New York State Department of Environmental Conservation(hereinafter referred to as the"Department".),with offices at 625 Broadway, Albany,New York 12233,and Elizabeth A. Neville , None as the Downer Mmunicipal clerk ❑manager of Town of Southold , 53095 Main Rand Business/Mpnicipality Name Street Addms Southold New Ynrk 11971 City/Town/Village State Zip Code (hereinafter collectively referred to as the"License Issuing Agent") WITNESSETH: WHEREAS,the Department is authorized by§ l l-0713 of the Environmental Conservation Law and applicable rules and regulations to appoint agents to issue licenses for the privilege of hunting and fishing in New York State;and , WHEREAS,the License Issuing Agent has applied to the Department for appointment as such a License Issuing Agent;and WHEREAS,the Department has determined that the License Issuing Agent is qualified to be appointed as a license issuing agent. NOW THEREFORE,the parties hereto agree as follows: 1. DEFINITIONS As used in this Agreement,the following,terms shall have the meaning provided herein: License Issuing Agent—shall mean both the License Issuing Agent and the License Issuing Officer as provided in 6 NYCRR§ 177.1(f)and(g)of the Department regulations and shall also mean the duly appointed owner,municipal clerk,or manager set forth above. Assistant License Issuing Agent—shall mean the individual appointed by the Licensing Issuing Agent to receive Department sponsored training for the,purpose of issuing sportsman licenses and to be the point of contact for any Department inquires. Approved location—shall mean the business' or municipality's address as set forth in the beginning of this Agreement. Page 1 of 10 2. APPOINTMENT A. The Department hereby appoints the License Issuing Agent and their duly appointed Assistant License Issuing Agent(designed below)to be an agent issuing hunting, trapping,and fishing Iicenses at the approved location. B. The License Issuing Agent hereby appoints, Carol A, Hydell., , Name T Ucou nt,_CIOR. ,,as the Assistant License Issuing Agent. 7`itle (See paragraph[11.F]herein for information regarding changes in appointment of the Assistant License Issuing Agent.) 3. DEPARTMENT REPRESENTATIONS The Department hereby agrees that it will: A. Provide the License Issuing Agent with a license printer(and necessary supplies) at the approved location for the sale and reporting of hunting and fishing licenses and provide necessary support for the printer. B. Pay a commission to the License Issuing Agent for each license sold as prescribed in Department laws,rules and regulations. C. Provide appropriate training and training materials to the Assistant License Issuing Agent,including a toll free telephone"help desk"service to answer questions and assist with problems. D. Provide informational materials for use at the approved location for the License Issuing Agent and their authorized employees to distribute to hunters,anglers,etc.,regarding regulatory requirements for all authorized licenses issued. 4. AGENT REPRESENTATIONS The Agent hereby agrees that it will: A. Provide authorization attached hereto as Attachment"A"for the Department to access a bank account for electronic fund transfers to pay for all licenses sold. Fund transfers shall be scheduled on a regular basis as determined by the Department. B. Provide reasonable and necessary security to protect equipment and supplies from damage and unauthorized use. C. Ensure that all Department license issuing equipment is maintained in good working condition and returned to the Department when license sales are no longer provided at the approved location. Page 2 of 10 D. Pay all amounts due to the Department.Failure to maintain an adequate balance in the License Issuing Agent's account may result in'immediate terminatioq of this Agreement, E. The License Issuing Agent must provide a compatible computer system including a plain paper printer and access to the internet at no charge to the Department. F. The License Issuing Agent agrees that it will indemnify and save harmless the Departmenf and the State of New-York from and against all losses from claims,demands, payments,suits,actions,recoveries and judgments of every nature and description brought or recovered against it in a court of competent jurisdiction,to the extent such loss is attributable to a negligent omission or tortious act of the License Issuing Agent,its agents or employees,in the . performance of this Agreement. 'G. The License Issuing Agent is solely responsible for the supervision and direction of the performance of this Agreement by the Assistant License Issuing Agent and other authorized license issuing employees other than as specifically provided herein. 5. AGENT RESPONSIBILITY A. General Responsibility:The License Issuing Agent shall at all times during the Agreement term remain responsible.The License Issuing Agent agrees,if requested by the Commissioner or his or her designee,to present evidence of its continuing legal authority to do business in New York State,integrity,experience,ability,prior performance,and organizational and financial capacity. B. Suspension of Work(for Non-Responsibility):The Commissioner or his or her designee,in his or her sole discretion,reserves the right to suspend any or ali activities under this Agreement,at any time,when he or she discovers information that calls into question the responsibility of the License Issuing Agent.In the event of such suspension,the License Issuing Agent will be given written notice outlining the particulars of such suspension.Upon issuance of such notice,the License Issuing Agent must comply with the terms of the suspension order. Agreement activity may resume at such time as the Commissioner or his or her designee issues a written notice authorizing a resumption of performance under the Agreement. b. LICENSE ISSUING CONDITIONS A. All licenses authorized to be sold pursuant to this Agreement may only be sold by the Assistant License Issuing Agent or authorized employees of the License Issuing Agent at the approved location set forth in this Agreement. B. All employees authorized to issue licenses by the License Issuing Agent pursuant to paragraph"A"of this section,shall be appropriately trained in the use of the license issuing system by the Assistant License Issuing Agent prior to using the issuance system, Page 3 of 10 C. The Assistant License Issuing Agent must receive recurring training sponsored by the Department at least once every three years or sooner as circumstances warrant as determined by the Department. D. The License Issuing Agent and its employees who are authorized to issue licenses pursuant to this Agreement must abide by New York State Regulations 6 NYCRR Part 177 (www.dec.ny goy/reqs/3936.html)and 6 NYCRR Part 183(www.dec.ny.gov/regs/393l.btml). E. All personal data provided by customers shall be kept confidential to the extent required by Law. F. All documents considered returnable documents as well as all voided licenses for which credit is requested must be returned to the Department within one month of the transaction. G. All funds received from the sale of licenses,less the commission fee established by the Department,will be held in trust for the Department. Monies collected from the sale of licenses are Department funds and any other use of such funds is prohibited. The License Issuing Agent accepts the responsibility and duties of trustee for all funds collected for the benefit of the Department under this Agreement. H. No license may be sold for a fee in excess of or less than the amount established by the Department. I. The complete catalog of sportsman licenses must be available for sale at the License Issuing Agent's approved location as designated in this Agreement. 7. USE OF EQUIPMENT AND SUPPLIES A. Supplies and equipment assigned to the License Issuing Agent for the printing of licenses are to be used for that purpose only,unless prior approval for such use is provided by the Department. Equipment is not transferable to�other license issuing agent locations. B. In the event that defective equipment is replaced,the License Issuing Agent shall return the defective equipment immediately to the specified repair center. The License Issuing Agent shall pay for any such equipment not returned,or equipment that shows obvious abuse. Failure to remit payment for abused or unretumed equipment may result in the immediate termination of this Agreement. 8. CIIANGE IN OWNERSHIP In the event of a change in ownership of the License Issuing Agent's business,the Department must be notified 30 days in advance of any such change,and this Agreement becomes immediately terminated at the time of such change in ownership.At the time of termination,all Department-provided licensing equipment must be returned to the Department or the Page 4 of 10 Department's representative. This License Issuing Agent's appointment is not transferable and shall apply only to the License Issuing Agent's appointment to sell hunting and fishing licenses. 9. CHANGE rN MUNICIPAL CLERK In the event of a change in municipal clerk from that who entered into this Agreement,the Department must be notified within 30 days of such change and this Agreement will become void at the time of such change.To avoid a disruption in service,a new Agreement should be submitted in advance of such change signed by the new municipal clerk.If the municipality intends to submit a new Agreement,Department-provided equipment does not need to be returned. 10. ' COMPLIANCE INSPECTIONS The Department reserves the right to inspect the approved location for the purpose of determining compliance with this Agreement. 11. TERMINATION In addition to any termination event appearing elsewhere in this Agreement,or provided in the applicable Department regulations,the following shall apply: A. This Agreement may be terminated for cause if the Department determines that any false statements or omissions were made on the License Issuing Agent's application. B. This Agreement may,be terminated for cause for failure to comply with the terms of this Agreement at any or all approved locations at anytime by the Department. C. . Either party may terminate this Agreement for convenience by 15 days written notice to the other party. D, In the event of termination of this Agreement,the License Issuing Agent shall pay for all licenses sold and not previously paid for and return all equipment and supplies.to the Department within 30 days of such termination. E. Termination for Non-Responsibility: Upon written notice to the License Issuing Agent,and a reasonable opportunity to be heard with appropriate Department officials or staff, the Agreement may be terminated by the Commissioner or his or her designee lit the License Issuing Agent's expense where the License Issuing Agent is determined by the Commissioner or his or her designee'to be non-responsible.In such event,the Commissioner or his or her designee may complete the contractual requirements in any manner he or she may deem advisable and pursue available legal or equitable remedies for breach. F. In the event of a change in the appointment of the Assistant License Issuing Agent,the License Issuing Agent shall notify the Department of such change within 15 business days by submitting to the Department a completed revised License Issuing Agent Application Page 5of10 Form attached hereto as Attachment"B,"which shall provide,among other things,the name and title of the newly appointed Assistant Licensing Issuing Agent.In the Department's sole discretion,this agreement may be suspended or terminated in the event the Department is not notified of any change in appointment of the Assistant License Issuing Agent as provided herein. 12. TERM This Agreement shall remain in effect from'the date of execution until such termination, 13. APPLICABLE LAWS A. This Agreement shall be governed by the laws of the State of New York. B. All licenses shall be issued in accordance with the provisions of the New York Codes,Rules and Regulations of the State of New York(hU://w*w.dec.ny.gov/rdgs/2494.html) and New York State Law and the policies and procedures of the Department. 14. TOTAL AGREEMENT This Agreement together with any laws,documents and instruments herein referenced,shall constitute the entire agreement and any previous communication pertaining to this Agreement is hereby superseded. 15. CONTRACT AMENDMENT Any agreement revisions,including payment adjustments or time extensions,shall be made by a written amendment to the agreement,signed by both parties, Signature Date: December 9, 2013 L'r nse Issuing Agent (n Uon required below) LICENSE ISSUING AGENT ACKNOWLEDGMENT State of New York ) )s,s„ County of Suffolk On the 9th day ofDec mber .in the year2013 before me,the undersigned,personally appeared E evi Ile personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capaeity(ies),and that by his/her/their signature(s)on the instrument,the indiviLJ%P,,p8% n upon behalf o£which the individual(s)acted,executed the instrument. NOTARY L{Pt1Qt.iC,State ol New York N0,01C04822563,Suffolk County Tenn Expires December 31,20-11L, Date Notary Expires Nota Public Page 6 of 10 Signature Date: DEC Representative NOTE:A faxed copy of this agreement and the associatdd application will not be accepted. Completed applications and agreements in their original form should be mailed to: Attn:Revenue and Accounting Unit New York State Departme4t of Environmental Conservation , 625 Broadway, I01'Floor Albany,New York 122334900 Page 7 of 10 Attachment A New York State Department of Environmental Conservation Division of Management&Budget Services Bureau of Revenue Management-101h Floor 625 Broadway,Albany,New York 12233-5012 Phone:(518)402-9365 a FAX:(518)402-9023 Website;www.dec.state.ny.us Please complete,review and sign this form.Attach a voided check or a statement from your bank that includes the routing number and account number for the account from which the ACH debits will be drawn and mail this items to the address above. New York State Department of Environmental Conservation Authorization Agreement for Direct Payments(ACH Debits)relative to the Department's automated sporting license system, Agent/OfficerName: Elizabeth A. Neville Business Address: 53095 Main Road. PO"Box 1179 City: Southold State: Now Yoram_' ZIP: Lt 971 Telephone; 1 hereby authorize the New York State Department of Environmental Conservation,hereinafter called DEPARTMENT,to initiate debit entries to my account indicated below at the financial institution named below,hereinafter called DEPOSITORY,and to debit the same account.I acknowledge that the origination of ACH Transactions to my account must comply with the provisions of U.S.law. Branch Name: Qrlda amptjp National Bank Address: 5tt970 1fAain Road City: Sosithold w State: RM Yoh ZIP Code: _11971 Contact: Linda Carlson-- Telephone: 631 765—1 kQ0 Routing Number: 121406667 Account Number: 0500027685 _ Account Name Town Clerk Cons Licenses Account Type: (M Checking U Savings L3 This authorization is to remain in full force and effect until DEPARTMENT has received written notification from me of its termination in such manner as to afford DEPARTMENT and DEPOSITORY a reasonable opportunity to act on it. Signature: Date: December 9, 2013 NOTE: ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION, Page 8 of 10 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION LICENSE ISSUING AGENT APPLICATION ATTACHMENT`B" ,= LICENSE ISSUING,AGENT PERSONAL INFORMATION FIRST,MIDDLE INITIAL,LAST NAME: Elizabeth A. NEville HOMEADDRESS: 110, Slee Hollow Lane STREET/PO BOX: CITY: o STATE; York ZIP CODE: 119 71 HOME TELEPHONE NUMBER: 631 765-2054 WORK TELEPHONE NUMBER:_631 765-1800 HAS APPLICANT SOLD NEW YORK STATE HUNTING AND FISHING LICENSES PREVIOUSLY? 3p YES o NO IF YES,PLEASE PROVIDE AGENT NUMBER: HAVE YOU EVER BEEN DENIED A BOND OR BEEN THE DEFENDANT IN COURT PROCEEDINGS INVOLVING THE NONPAYMENT OF DEBTS? a YES X NO HAVE YOU EWER BEEN CONVICTED OF A FELONY? o YES 14 NO IS THE AGENT 18 YEARS OF AGE OR OLDER? Al YES o NO POSITION OF APPLICANT: a OWNER MUNICIPAL CLERK o MANAGER BUSINESS INFORMATION LEGAL NAME OF BUSINESS OR MUNICIPALITY: Town of Southold FEDERAL EMPLOYER IDENTIFICATION NUMBER: TYPE OF BUSINESS; IK GOVERNMENT D SOLE PROPRIETORSHIP D CORPORATION o PARTNERSHIP a LIMITED PARTNERSHIP BUSINESS MAILING ADDRESS: -53095-Main Road STREET/PO BOX: Post Office Box 1179 CITY: SouthaldSTATE: York ZIP CODE: 11971 BUSINESS SHIPPING ADDRESS(If Different From Above) STREET ADDRESS CITY STATE: ZIP CODl3; BUSINESS TELEPHONE NUMBER:631 765-1800 BUSINESS FAX NUMBER:631 765-6145 BUSINESS E-MAIL ADDRESS: e.neville@town.southold.n .us 1HAS THIS BUSINESS LOCATION SOLD NEW YORK STATE HUNTING AND FISHING LICENSES PREVIOUSLY? )(I YES a NO - IF YES,PLEASE PROVIDE AGENT NUMBER: 5211 Page 9 of 10 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION LICENSE ISSUING AGENT AGREEMENT (Do not alter this Agreement. If information is incorrect, please call the New York State Department of Environmental Conservation at 518-402-9365.) This Agreement entered into between the New York State Department of Environmental Conservation (hereinafter referred to as the "Department"), with offices at 625 Broadway, Albany,New York 12233, and Elizabeth A. Neville-. , Name as the Oowner 21municipal clerk Omanager of Toxym of Southold 53095, Main road., P.O. Box 1179 , Business/Municipality Name Street Address Southold New York , 11971 City/TownNillage State Zip Code (hereinafter collectively referred to as the "License Issuing Agent") WITNESSETH: WHEREAS, the Department is authorized by§ 1 1-0713 of the Environmental Conservation Law and applicable rules and regulations to appoint agents to issue licenses for the privilege of hunting, fishing and trapping in New York State; and WHEREAS, the License Issuing Agent has applied to the Department for appointment as such a License Issuing Agent; and WHEREAS, the Department has determined that the above License issuing Agent applicant is qualified to be appointed as a license issuing agent. NOW THEREFORE, the parties hereto agree as follows: 1. DEFINITIONS As used in this Agreement, the following terms shall have the meaning provided herein: License Issuing Agent—shall mean both the License Issuing Agent and the License Issuing Offices-as provided'tn 6 NYCRR 5 177 1(t) arid'(-) of the Department regulations and shall also mean the duly appointed owner, municipal clerk, or manager set forth above. Assistant License IsszlingAgent—shall mean the individual appointed by the Licensing Issuing Agent to receive Department-sponsored training for the purpose of issuing sporting licenses and to be the point of contact for any Department-inquires. AppMved location—shall mean the business' or municipality's address as set forth in the beginning of this Agreement. Page I of 10 2. APPOINTMENT A. The Department hereby appoints the License Issuing Agent and their duly appointed Assistant License Issuing Agent (designated below)to be an agent issuing hunting, trapping, and fishing licenses at the approved location. B. The License Issuing Agent hereby appoints Lys da K. Rudder , Name Deputy Toru Clerk , as the Assistant License Issuing Agent. Title (See paragraph [I I F] herein for information regarding changes in appointment of the Assistant License Issuing Agent.) 3. DEPARTMENT REPRESENTATIONS The Department hereby agrees that it will: A. Provide the License Issuing Agent with a license printer (and necessary supplies) at the approved location for the sale and reporting of hunting, fishing and trapping licenses and provide necessary support for the printer. B. Pay a commission to the License Issuing Agent for each license sold as prescribed in Department laws, rules and regulations. C. Provide appropriate training and training materials to the Assistant License Issuing Agent, including a toll-free telephone "help desk" service to answer questions and assist with problems. D. Provide informational materials for use at the approved location for the License Issuing Agent and their authorized employees to distribute to hunters, anglers, trappers, etc., regarding regulatory requirements for all authorized licenses issued. 4. AGENT REPRESENTATIONS The Agent hereby agrees that it will: A. Provide authorization attached hereto as Attachment"A" for the Department to access a bank account for electronic fund transfers to pay for all licenses sold. Fund transfers shall be scheduled on a regular basis as determined by the Department. B. Provide reasonable and necessary security to protect equipment and supplies from damage and unauthorized use. C. Ensure that all Department license issuing equipment is maintained in good working condition and returned to the Department when license sales are no longer provided at the approved location. I Page 2of10 Environmental Analyst, Department of Public Works Southold Town 53095 Main Rd, Southold, ICY 11971 631-765-1283 craigi@southoldtownny.gov r 2 . 5 Neville, Elizabeth From: dec.sm Supervisor License <Supervisor License@dec ny.gov> Sent: Friday, October 16, 2020 1.38 PM To: Jobes, Craig Ce: Rudder, Lynda; Foote, Nancy, Neville, Elizabeth Subject: Re- New Agent of Record Attachments: LIA Agreement V413 pdf Sorry for the delay, we have had a huge influx of these requests due to agents letting us know about AOR changes more recently instead of when they occurred (this may or may not be your particular situation but it has created a back log). This change cannot be done just by email us. We need a new agent agreement (attached)completed and sent back to the address listed in the agreement itself. Once Revenue receives and reviews that agreement they will let me know so we can move forward. Unfortunately, this will not be a quick process. We will move thing forward as fast as we can while we are in our busy season, working with less staff and working through a new license issuing system. Thanks, Kevin Maloney NYS DEC License Sales From:Jobes, Craig <craigJ@southoldtownny.gov> Sent:Thursday, September 3, 2020 9:28 AM To: dec.sm.Supervisor.License <Supervisor.License @dec ny.&oy> Cc: Rudder, Lynda <Ivnda.rudder@town.SOLltliold.ny,Lls>; Foote, Nancy<nancy.foote@town.southoId.ny.us>; e.neville@town.southold.ny,us<e.neville@town.southold.ny.us> Subject: New Agent of Record �s� ^"�'a .,.-r �� r �•''`���,—;._,,•-"•"—:i4"�""� ��-A e� �8 d'��'�ti��.��w'a7'1'�. �,x"�"���,���^y.`°.�?+:r �,Y+� ''a � d��"v"r'" w��yw �" ��''�.,,. ..�erx i � ��''°'�?��'��?,�' a��3�23��t�'9�;..�p,��l�"+34�'�,�1" .*�7�,v,�r. �T'�„ s�����r�� �'�+i.�<h�`,x'PtFB`'1a-F�a1r��!�.�a?I���lt��'`kr.�,re c h�±� ''��;2 ���:�.''.p,�, e � "d g` o k�,.,•x,, ;' ".`f«, t��;,fie e 1�`..:',"• ¢`,rr ,xa'� mP C:�:c.�.�'�a 5a-$ �Q d M�-kx"i'��5.�'"� y,�`"' �.,_ `�;�A,'.y x��'=;.°�'`" �6-.a�,�,p°�` ����e I D#2059 Old: Carol Hydell New: LYNDA RUDDER This is the second attempt to have this changed. Please make the appropriate changes ASAP so that we can begin printing and issuing licenses. Thank You Craig D Joe 1 BUSINESS OPERATIONS DAYS/HOURS OF OPERATION DAY OF WEEK OPENING FINE CLOSING TIME SUNDAY AM PM AM PM MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY IS THIS BUSINESS OPEN YEAR AROUND? ❑ YES ❑ NO IF NO,STATE MONTHS OF OPERATION ASSISTANT LICENSE ISSUING AGENT INFORMATION (To be appointed by the License Issuing Agent listed above) FIRST,MIDDLE INITIAL,LAST NAME DOB: HOME ADDRESS: STREET/PO BOX. CITY: STATE: ZIP CODE: HOME TELEPHONE NUMBER: NVORK TELEPHONE NUMBER: HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY LEVEL CRINIMAL OFFENSE?* ❑ YES ❑ NO IF YOU HAVE ANSWERED"YES",PLEASE PROVIDE THE FOLLOWING: i. Certificate of Disposition or similar document If the conviction occuired in another state, u A signed and dated statement deset ibmg the convic,tunl(s) Including Sutfficienl detail ol'events leading up to the conviction and any post- conviction rehabilitation and good conduct, III One or more letters of recommendation from someone other than a relative and any additional documentation relevant to review ofthe application,such as a certificate of relief from disability and documentation showing personal accomplishments since the conviction(s), including professional licenses,rehabilitation documents,courses or degrees *Note:A response of yes to the above question is not an absolute bar to serving as a license issuing agent or assistant license issuing agent. IS THE ASSISTANT AGENT 18 YEARS OF AGE OR OLDER? ❑YES ❑ NO License Issuing Agent Applicant Certification and Signature The undersigned recognizes that this application is submitted foi the expi ess pui pose of inducing the State oi'New York,through the Department,to appoint me as a license issuing agent with the authority to ISSue hunting,Uappmg,and fishing privileges in the State of'New Yotk,acknowledges that the State or the Department may,by means which it may choose.deter mine the a uth and accui acy of all statements made herein,acknowledges that intentional submission of false or misleading information may constrtutc a felony of nusdemcanoi undet Penal Law§210.and states that the information submitted in this application and any attached pages is true,accurate and complete Signed: Dated: License Issuing Agent Page 10 of 10 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION LICENSE ISSUING AGENT APPLICATION Aft ATTACHMENT "P" Naw LICENSE ISSUING AGENT PERSONAL INFORMATION FIRST,MIDDLE INITIAL, LAST NAME: DOB: HOME ADDRESS: STREET/PO BOX. CITY: STATE: ZIP CODE: HOME TELEPHONE NUMBER: WORK TELEPHONE NUMBER: HAS APPLICANT SOLD NEW YORK STATE HUNTING AND FISHING LICENSES PREVIOUSLY?❑ YES ❑NO IF YES,PLEASE PROVIDE AGENT NUIVIBER: ARE THERE ANY OU'TSTANDING LIENS AGAINST OR,IITDGN1ENI'S IN THE NAME OF THE APPLICANT?❑YES ❑ NO HAVE YOU BEEN CONVICTED OF A MISDEMEANOR OR FELOiNN' LEVEL CRIMINAL OFFENSE'.'* ❑ YES ❑ NO IF YOU HAVE ANSWERED"YES",PLEASE PROVIDE 1 Fns FOLLON1 ING• i. Ceitificate of Disposition or sunilai document if the conviction occurred in another state, ti. A signed and dated statement desci ibing the conviction(,), including sufficient detail of events leading up to the conviction and any post-conviction rehabilitation and good conduct. iii. One of more letters of recommendation fiom someone other than a relative and any additional documentation relevant to review of the application,such as a certificate of relief from disability and documentation showing personal accomplishments since the conviction(s). including professional licenses,iehabditation documents,courses or degrees. *Note:A response of yes to the above question is not an absolute bar to serving as a license issuing agent or assistant license issuing agent. IS THE APPLICANT 18 YEARS OF AGE OR OLDER? ❑YES ❑ NO BUSINESS INFORMATION LEGAL NAME OF BUSINESS OR MUNICIPALITY: FEDERAL EMPLOYER IDENTIFICATION NUMBER: TYPE OF BUSINESS: ❑ GOVERNMENT ❑ SOLE PROPRIETORSHIP❑ CORPORATION ❑PARTNERSHIP O LIMITED PARTNERSHIP BUSINESS MAILING ADDRESS: STREET/PO BOX: CITY: STATE: ZIP CODE: BUSINESS SHIPPING ADDRESS(If Different From Above) STREET ADDRESS CITY STATE: ZIP CODE: BUSINESS TELEPHONE NUMBER: BUSINESS FAX NUMBER: BUSINESS E-MAIL ADDRESS: HAS THIS BUSINESS LOCATION SOLD NEW YORK STATE HUNTING AND FISHING LICENSES PREVIOUSLY? ❑YES ❑ NO IF )'ES, PLEASE PROVIDE AGENT NUMBER: Page 9 of 10 Attachment A New York State Department of Environmental Conservation Division of Management& Budget Services Bureau of Revenue Management-10`x'Floor 625 Broadway,Albany,New York 12233-5012 Phone:(518)402-9365 • FAX: (518)402-9356 Website:www.dec state.ny.us Please complete, review and sign this form Attach a voided check or a statement from your bank that includes the routing number and account number for the account from which the ACH debits will be drawn and mail this items to the address above. New York State Department of Environmental Conservation Authorization Agreement for Direct Payments(ACH Debits) relative to the Department's automated sporting license system. Agent/Officer Name: Business Address. City. State: ZIP: Telephone: I hereby authorize the New York State Department of Environmental Conservation,hereinafter called DEPARTMENT,to initiate debit enti ies to my account indicated below at the financial institution named below, hereinafter called DEPOSITORY,and to debit the same account. 1 acknowledge that the origination of ACH Transactions to my account must comply with the provisions of U.S. law. Branch Name: Address: City: State: ZIP Code: Contact: Telephone: Routing Number: ACCOUnt NUmber- AccountName Account Type: L] Checking L] Savings [_] This authorization is to remain in full force and effect until DEPARTMENT has received written notification from me of its termination in such manner as to afford DEPARTMENT and DEPOSITORY a reasonable opportunity to act on it. Signature: Date: NOTE: ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION. Page 8 of 10 Signature Date: DEC Representative NOTE: A faxed copy of this agreement and the associated application will not be accepted. Completed applications and agreements in their original form should be mailed to: Attn: Revenue and Accounting Unit New York State Department of Environmental Conservation 625 Broadway, 101h Floor Albany, New York 12233-4900 Page 7 of 10 12. TERM This Agreement shall remain in effect from the date of execution until such termination. 13. APPLICABLE LAWS A. This Agreement shall be governed by the laws of the State of New York. B. All licenses shall be issued in accordance with the provisions of the New York Codes, Rules and Regulations of the State of New York(http://www.dee.nYgov/regs,/2494.htmi) and New York State Law and the policies and procedures of the Department. 14. TOTAL AGREEMENT This Agreement together with any laws, documents and instruments herein referenced, shall constitute the entire agreement and any previous communication pertaining to this Agreement is hereby superseded. 15. CONTRACT AMENDMENT Any agreement revisions, including payment adjustments or time extensions, shall be made by a written amendment to the agreement, signed by both parties. Signature Date: License Issuing Agent (notarization requued below) LICENSE ISSUING AGENT ACKNOWLEDGMENT State of New York ) )s.s. County of Suffolk ) On the day of in the year before me,the undersigned,personally appeared F1 i zah-Ptb A-rev%lle personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies),and that by his/her/their signature(s)on the instrument,the individual(s),or the person upon behalf of which the individual(s)acted,executed the instrument. Date Notary Expires Notary Public Page 6 of 10 9. CHANGE IN MUNICIPAL CLERK In the event of a change in municipal clerk,from that who entered into this Agreement, the Department must be notified within 30 days of such change and this Agreement will become void at the time of such change. To avoid a disruption in service, a new Agreement should be submitted in advance of such change signed by the new municipal clerk. If the municipality intends to submit a new Agreement, Department-provided equipment does not need to be returned. 10. , COMPLIANCE INSPECTIONS The Department reserves the right to inspect the approved location for the purpose of determining compliance with this Agreement. 11. TERMINATION III addition to any termination event appearing elsewhere in this Agreement, or provided in the applicable Department regulations, the following shall apply: A. This Agreement may be terminated for cause if the Department determines that any false statements or omissions were made on the License Issuing Agent's application. B. This Agreement may be terminated for cause for failure to comply with the terms of this Agreement at any or all approved locations at any time by the Department. C. Either party may terminate this Agreement for convenience by 15 days written notice to the other party. D. III the event of termination of this Agreement, the License Issuing Agent shall pay for all licenses sold and not previously paid for and return all equipment and supplies to the Department \vithin 30 days of such termination. E. Termination for Non- Responsibility- Upon written notice to the License Issuing Agent, and a reasonable opportunity to be heard with appropriate Department officials or staff, the Agreement may be terminated by the Commissioner or his or her designee at the License Issuing Agent's expense where the License Issuing Agent is deter•inmed by the Commissioner or his or her designee to be non-responsible. In such event, the Coin III issioner or his or her designee may complete the contractual requirements in any manner he or she may deem advisable and pursue available legal or equitable remedies for breach. F In the event of a change in the appointment of the Assistant License Issuing Agent, the License Issuing Agent shall notify the Department of such change within 15 business days by submitting to the Department a completed revised License Issuing Agent Application Form attached hereto as Attachment"B," which shall provide, among other things, the name and title of the newly appointed Assistant Licensing Issuing Agent In the Department's sole discretion, this agreement may be suspended or terminated in the event the Department is not notified of any change in appointment of the Assistant License Issuing Agent as provided herein. Page � of10 r 0 C. The Assistant License Issuing Agent must receive recurring training sponsored by the Department at least once every three years or sooner as circumstances warrant as determined by the Department. D. The License Issuing Agent and his/her employees who are authorized to issue licenses pursuant to this Agreement must abide by New York State Regulations 6 NYCRR Part 177 (www.dee.ny.aov/refas/L3 hhtini) and 6 NYCRR Part 183 (www.dec.ny. og v/reps/3931.htmI). E. All personal data provided by customers shall be kept confidential to the extent required by Law. F. All documents considered returnable documents as well as all voided licenses for which credit is requested must be returned to the Department within one month of the transaction. G. All funds received from the sale of licenses, less the commission fee established by the Department, will be held in trust for the Department. Monies collected from the sale of licenses are Department finds and any other use of such funds is prohibited. The License Issuing Agent accepts the responsibility and duties of trustee for all funds collected for the benefit of the Department under this Agreement. H. No license may be sold for a fee in excess of or less than the amount established by the Department. I. The complete catalog of sporting licenses must be available for sale to the public at the License Issuing Agent's approved location as designated in this Agreement. 7. USE OF EQUIPMENT AND SUPPLIES A. Supplies and equipment assigned to the License Issuing Agent for the printing of licenses are to be used for that purpose only, unless prior approval for such use is provided by the Department. Equipment is not transferable to other license issuing agent locations. B. In the event that defective equipment is replaced, the License Issuing Agent shall return the defective equipment immediately to the specified repair center. The License Issuing Agent shall pay for any such equipment not returned, or equipment that shows obvious abuse. Failure to remit payment for abused or unreturned equipment may result in the immediate termination of this Agreement. 8. CHANGE IN OWNERSHIP In the event of a change in ownership of the License Issuing Agent's business, the Department must be notified 30 days in advance of any such change, and this Agreement becomes immediately terminated at the time of such change in ownership. At the time of termination, all Department-provided licensing equipment must be returned to the Department or the Department's representative. This License Issuing Agent's appointment is not transferable and shall apply only to the License Issuing Agent's appointment to sell sporting licenses. Page 4 of 10 D. Pay all amounts due to the Department Failure to maintain an adequate balance in the License Issuing Agent's account may result in immediate termination of this Agreement. E. Provide a compatible computer system including a plain paper printer and access to the internet at no charge to the Department. F. Indemnify and save harmless the Department and the State of New York from and against all losses from claims, demands, payments, suits, actions, recoveries and judgments of every nature and description brought or recovered against it in a court of competent jurisdiction, to the extent such loss is attributable to a negligent omission or tortious act of the License Issuing Agent, its agents or employees, in the performance of this Agreement. G. Be solely responsible for the supervision and direction of the performance of this Agreement by the Assistant License Issuing Agent and other authorized license issuing employees other than as specifically provided herein. H. Alert the Department if the License Issuing Agent, Assistant License Issuing Agent or other person issuing licenses is convicted of a misdemeanor or felony level criminal offense. 1. Not allow a person convicted of a misdemeanor or felony level criminal offense to issue licenses or have access to the license system, unless the person's conviction has been reviewed by DEC. 5. AGENT RESPONSIBILITY A. General Responsibility: The License Issuing Agent shall at all times during the Agreement term remain responsible. The License Issuing Agent agrees, if requested by the Commissioner or his or her designee, to present evidence of its continuing legal authority to do business in New York State, integrity, experience, ability, prior performance, and organizational and financial capacity. B. Suspension of Work (For Non-Responsibility): The Commissioner or his or her designee, in his or her sole discretion, reserves the right to suspend any or all activities under this Agreement, at any time, when lie or she discovers information that calls into question the responsibility of the License Issuing Agent. In the event OF Such suspension, the License Issuing Agent will be given written notice outlining the particulars of such suspension. Upon issuance of such notice, the License Issuing Agent must comply with the terms of the suspension order. Agreement activity may resume at such tine as the Commissioner or his or her designee issues a written notice authorizing a resumption of performance Under the Agreement. 6. LICENSE ISSUING CONDITIONS A. All licenses authorized to be sold pursuant to this Agreement may only be sold by the License Issuing Agent, the Assistant License Issuing Agent or authorized employees of the License Issuing Agent at the approved location set forth in this Agreement. B. All employees authorized to issue licenses by the License Issuing Agent pursuant to paragraph "A" of this section, shall be appropriately trained in the use of the license issuing system by the Assistant License Issuing Agent prior to using the issuance system. Page 3 of 10 BUSINESS OPERATIONS DAYS/HOURS OF OPERATION F DAY OF WEEK OPENING TIME CLOSING TIME SUNDAY Slosed AM PM _AM _PM BAO-AM g:00 PM MONDAY TUESDAY 8:00 AM 4:00 PM WEDNESDAY 8:00-AM THURSDAY 4:00 PM FRIDAY :00 AM 4.00 PM SATURDAY Closed IS•THIS BUSINESS OPEN YEAR AROUND? )jYES o NO IF NO,STATE MONTHS OF OPERATION: ASSISTANT LICENSE ISSUING AGENT INFORMATION (To be appointed by the License Issuing Agent listed above) FIRST,MIDDLE INITIAL..,LAST NAME: - Carol A.. Hydell HOMEADDRESS: 150 Henry's Lane STREET/PO BOX.- CITY: OX:CITY: Southold STATE: New York ZIP CODE: 8 HOME TELEPHONE NUMBER: 631 Zfi5-8461 WORK TELEPHONE NUMBER: HAVE THE ASSISTANT AGENT EVER BEEN CONVICTED OF A FELONY? a YES )1P NO IS THE ASSISTANT AGENT 18 YEARS OF AGE OR OLDER? JqYES ONO License Issuing Agent Applicant Certification and Signature: The undersigned recognizes that this application is submitted for the express purpose of inducing the State ofNew York,through the Department,to appoint me as a license issuing agent with the authority to issue hunting, trapping,and fishing privileges in the State of New York;acknowledges that the State or the Department may,by means which it may choose,determine the truth and accuracy of all statements made herein;acknowledges that intentional submission of false or misleading information may constitute a felony or misdemeanor under Penal Law§210;and states that the information submitted in this application and any attached pages is true,accurate and complete. Signed: Dated: December 9, 2013 cense Issuing Agent Page 10 of 10