Appendix B Fishing Permit Application Saint Regis Mohawk TribeCompliance Department412 State Route 37 Akwesasne, NYPhone (518) 358-2272TEMPORARY NON MEMBER FISHING PERMITThree Day Permit ☐ Full Season ☐(3 day permit is from date of issue)Date Issued: ______/_______/____________ ~ Valid Thru: ______/_______/____________First Name: _________________________________ Last Name: _________________________________Address: ___________________________________ City: ______________________________________State/Prov: _________________ Postal Code/ZIP: _____________ Phone #: (____) _______-___________I certify that I understand the Saint Regis Mohawk Tribe's rules and regulations governing fishing within SRMT territory waters. I understand my responsibility, obligations to property, health and safety of the community upon this permit's approval. I certify that I will pay fees due to the Saint Regis Mohawk Tribe.Permit Applicant Signature: ___________________________________Agent Signature: __________________________ Authorized Signature: ___________________________Fee: $____________.00 Permit #:PRINTED BY FASPRINT * 518-483-4831. *www.fasprint.com
