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OLD , City of Gem Lake Heritage Hall 4200 Otter Lake Road I Gem Lake, MN 55110 651-747-2790/921651-747-2795 (fax) E-mail ci rah 7etrtlrtken�rt Permit to Allow Archery Deer Hunting in the City of Gem Lake PEP -MIT APPLICATION CHECKLIST: To prevent delay, please ensure the following information is submitted ❑ Application Fee (if paying with cash we can only accept exact change) El S 10a,00 1 S500;00 Security Deposit (separate check from fee) ❑ 5 Plus Acre Parcel Verified ❑ Bow Hunter. Education Certificate C3 DNR Permits ❑ Deer Stand Locations/Parcel/Building Location/Shooting Lanes ❑ Bow Hunter Education Certificate Permission is hereby given to located at �- �-^ � ,owner of the property L r Gem Lake, Minnesota, to allow archery deer hunting on the property. The fallowing guidelines must be followed or you will be in violation of Ordinance No. I24B:. • The permit to allow archery deer hunting on your property shall run from to el * o � I r 41G 20- �_ (three consecutive week maximum); • Shooting ofthe bow and arrow shall be on the following three days ofeach week only: tT15UQ • A copy of this Permit must be displayed on the premises; and • Additional requirements of the Gem lake City Council are listed on the reverse side of this permit. Date Mayo City of Uem Lake I/we, Fid f iC r4 have read and understand the above requirements. q Date Pro i Signature (all owners mujt si,en) Office Use Only ❑ 5. PIus Acre Parcel Verified ❑ $100,00 Fee Paid: Cl $500;00 Security Deposit © Bow Hunters Education Certificate Verified ❑ DNR Permits Verified Deer stand locations/pareel/buildings location/shooting lanes Property Owner Signature. ❑ City Council Approved Date: O Deer Harvest Report Received Date. ED Security Deposit Returned Date; Archery Dccr Hunting Permit Page i I