New York Form Btd 1 – Fill Out and Use This PDF

BLACK BEAR TRACKING DOG - 1 YEAR LICENSE APPLICATION

8. Do You Possess a Valid New York State License Which Authorizes You To Take Big Game In New York State?

Yes

No

List Your License Number

9.I understand that if I receive a Black Bear Tracking Dog License, all dogs used under the authority of my license MUST be licensed, vaccinated and identified as required by NYS Agriculture and Markets Law and that only the following breeds or crosses among these breeds may be used to track Black Bear: Airedale, American Black and Tan Coonhound, Bluetick Coonhound, Majestic Tree Hound, Mountain Cur, Leopard Cur, English Coonhound, Plott Hound, Redbone Coonhound, and Treeing Walker.

Yes

No

10.Within the last FIVE years, have you ever been convicted of or pled guilty to an offense under the NYS Fish and Wildlife Law, or settled by civil compromise or otherwise therefore, which resulted in a revocation of your Big Game Hunting or Archery License?

Yes	No	If Yes, describe the nature of, and list the date(s) of the incident(s):

11. List the breed of dog and the license number for each dog (attach additional sheets if necessary).

Breed		Dog License or Kennel License Number

12.In order of preference, list the region number where you would like to volunteer your services in alleviating damage caused by Black Bears: (see attachment for Region Numbers)

(A) Top Preference:

(B) Also interested in assisting in Regions:

NOTICE: Pursuant to ECL Section 3-0301(2)(Q) false statements made on this application are punishable pursuant to Section 210.45 of the New York State Penal Code.

Date	Signature of Applicant

BLACK BEAR TRACKING DOG - 1 YEAR LICENSE APPLICATION

Instructions

STATUTORY AUTHORITY: Environmental Conservation Law Section 11-0928 and 6 NYCRR Part 175 and 187.

The Department of Environmental Conservation (DEC) may issue a Black Bear Tracking Dog License to a qualified individual to train black bear tracking dogs on black bear in accordance with and pursuant to the conditions of each license.

The following instructions correspond numerically with the numbers on the Black Bear Tracking Dog License Application. When completing this application, please provide sufficient detail to fully answer the questions. The answers you provide are the criteria for approving or denying your license. Incomplete or vague applications will be returned to the applicant.

1.Name of applicant.

2.If applying as a business or organization list the name of the business.

3.Mailing address and county of residence of the applicant.

4.Day and night telephone number of the applicant.

5.Date of birth of the applicant.

6.Please check the appropriate box.

7.If renewing a previous Black Bear Tracking Dog License, list the previous license number.

8.Check either yes or no. You must possess a current New York State License which authorizes you to legally take big game. Please provide the license number of the license which authorizes you to legally take big game in New York.

9.Check either yes or no. Only certified black bear tracking dogs may be used under a Black Bear Tracking Dog License. A certified tracking dog means a dog which is one of the following breeds or a cross among these breeds: Airedale, American Black and Tan Coonhound, Bluetick Coonhound, Majestic Tree Hound, Mountain Cur, Leopard Cur, English Coonhound, Plott Hound, Redbone Coonhound and Treeing Walker and is licensed, collared, identified and vaccinated against rabies in accordance with Agriculture and Markets Law.

10.Check either yes or no. If you check yes, please describe the nature of the incident and list the date of the violation or incident.

11.List the breeds or crosses among breeds and dog license number for each certified black bear tracking dog that you own or wish to train. If necessary, continue list on a separate sheet of paper.

12.Persons who hold a valid Black Bear Tracking Dog License are eligible to assist landowners experiencing damage caused by bears pursuant to a permit issued by the Department of Environmental Conservation.

If interested, please list under 12A the DEC region of the State (see below) where you would prefer to assist such landowners. If you are willing to assist in additional regions, please list them under 12B.

Region: Counties Included:

1 & 2 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk

3Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester

4Albany, Columbia, Delaware, Greene, Montgomery, Otsego, Rensselaer, Schenectady, Schoharie

5Clinton, Essex, Franklin, Fulton, Hamilton, Saratoga, Warren, Washington

6Herkimer, Jefferson, Lewis, Oneida, St. Lawrence

(continued on next page)

BLACK BEAR TRACKING DOG - 1 YEAR LICENSE APPLICATION

Instructions (continued)

Region: Counties Included:

7Broome, Cayuga, Chenango, Cortland, Madison, Onondaga, Oswego, Tioga, Tompkins

8Chemung, Genesee, Livingston, Monroe, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Yates

9	Allegany, Cattaraugus, Chautauqua, Erie, Niagara, Wyoming

Please read the NOTICE and sign and date on the appropriate lines provided at the bottom of the application.

The fee for a Black Bear Tracking Dog - 1 Year License is $25.00, valid for one year from the date of issuance. Send your completed application and a check for $25.00, payable to NYS Department of Environmental Conservation to:

New York State Department of Environmental Conservation

Special Licenses Unit

625 Broadway

Albany, New York 12233-4752

Approximately 45 days are required to review and process completed applications.