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APPLICATION TO NA- 01525 -04 (revised 04/2012) <br /> CONDUCT A FISHING TOURNAMENT <br /> INSTRUCTIONS <br /> 1. Complete all information requested below and sign. <br /> 2. Submit a copy of the Tournament Rules with this application. <br /> 3. Permit applications will be accepted from August 1 for contests being held the following year. Applications received before the last <br /> Friday in September will be eligible for a drawing if more applications are received for a given water -body than available permits. <br /> Other applications will be handled on a first -come, first -serve basis. <br /> 4. Permit Fees are $60 for small contests (31 -100 participants, 50 or fewer boats), $200 for large contests (more than 100 participants or <br /> more than 50 boats), or $120 for ice contests. Off -site weigh -in fees are $250 for small contests or $500 for large contests. Submit fee <br /> with this application. See DNR website for details. <br /> Tournament Name: 31 st Annual Centerville Lions Ice Fishing Contest <br /> Name of Permittee (must be a Minnesota Resident) Daytime Telephone Number (include Area Code) <br /> Greg Kieselhorst 612- 221 -9122 <br /> Address of Permittee (No. & Street, RFD, Box No., City, State, Zip Code) <br /> 7155 Brian Drive, Centerville, MN 55038 <br /> Name of Sponsor (organization, firm, or individual) <br /> Centerville Lions Club <br /> Name of Tournament Waters / D.O.W. ID Number: Acres Counties <br /> Centerville Lake / 02000600 474 Anoka <br /> List Boat Accesses to be Used: <br /> Old Waterworks; off County Road 14 on North Side <br /> Tournament Fish Species: All Legal Fish; DNR Regulations that apply on Saturday February 16th 2013 <br /> List the Tournament Limit per Angler (if more than one species, list individual species separately): <br /> No set Limit; DNR Regulations will apply <br /> List weigh -in Station(s): Central located Ice Fishing House in the Contest Area <br /> Have you conducted a fishing contest requiring a DNR permit within the last five years (circle) ? Yes) No <br /> If yes, name of tournament 30th Annual Centerville Lions Ice Fishing Contest <br /> Date of tournament 2/18/2012 <br /> Water Body Name Centerville Lake <br /> Permit Number (if known) <br /> Have you ever failed to make required prize awards (circle) ? Yes NO) <br /> Will this tournament include live release provisions (circle) ? For which species? All Species Yes) NO <br /> Estimated No. of Estimated No. of Boats Tournament Dates (month- day -year) Daily Fishing Hours <br /> Entrants <br /> 100 -1,000 0 From: 2/16/2013 To ' 2/16/2013 From: 11 A.M. To: 2 P.M. <br /> Entry Fee per Total Prize Value AJ Individual <br /> 5.00 per Hole s 5,000 signature of Permittee f Date 12/17/2012 <br /> 28 <br />