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2. Name*
4. Address*
6. Phone Number*
8. Area access is needed for:

   1. Cedar Hills
   2. East Idlewild
   3. Happy Acres
   4. Knapp I Wildlife
   5. Knapp II Wildlife
   6. Little Cedar Wildlife Area
   7. Mink Creek

   1. Nagle Wildlife Area
   2. Rock Creek Wildlife
   3. Slough Creek
   4. Stricker's Fen
   5. Wentlands Woods
   6. Winterink Wood
10. Season that you plan to hunt*
12. This permit is only valid during the hunting season listed.
    Motorized travel will be restricted to the area(s) marked on the map provided with this permit. Failure to keep gates closed or travel off of the marked trails will result in revocation of this permit. Violation of state code or county ordinances will also result in revocation of this permit.
14. Please attach . . .*
    Notification from a Physician regarding verification of a medical condition (temporary or permanent) that prevents normal ambulatory travel and requires you to need the use of a motorized vehicle.
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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