TERMS OF PERMIT
[Pages:1]Department of Fish & Wildlife Resources 1 Sportsman's Lane
Frankfort, Kentucky 40601
HUNTING METHODS EXEMPTION ? CROSSBOW PERMIT
NAME:_____________________________________ PHONE(___)__________ ID#(SSN OR DRIVERS LICENSE)_____________________
ADDRESS_______________________________________________ CITY______________________________ STATE_____ ZIP________
The following is to be filled out by a licensed physician.
I do hereby attest that the above named individual is not able to use conventional archery equipment and must use a crossbow because:
_______________________________________________________________________________________________________
(description of disability)
This disability is temporary ___________________or permanent_________________________
(length of time is required)
TERMS OF PERMIT
1. Once completed and signed this application will be your HUNTING METHODS EXEMPTION PERMIT. 2. The permit holder is authorized to use a crossbow during archery seasons. 3. The crossbow must conform to provisions of applicable regulations. 4. All other statutes and regulations must be observed. 5. Permit holder must possess appropriate KY hunting licenses and tags. 6. This permit must be carried on person. 7. If the disability is a temporary one this individual must return to conventional hunting methods at the end of the time
specified above. 8. The Department of Fish and Wildlife does not maintain any copies of this permit. It is the responsibility of the user to
maintain this document. 9. The Department of Fish and Wildlife does not assume any responsibility or liability for any activity conducted under
this permit. The user assumes all risks and responsibilities.
_____________________________________________________
Signature of licensed physician
_____________________________________________________
Business address
_____________________________________________ ______________________________ _______ (____)_______________________
Print Name
City
State Phone Number
I ______________________________________ have read and agree with to comply with all the above terms. Applicant Signature
__________________
Date
Once this form is completed, please do NOT return it to KDFWR.
THIS IS YOUR PERMIT
................
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