2012TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W.TOWNOF WAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-1478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
July 27, 2012
Revenue Accounting Unit
NYS Dept. of Conservation
625 Broadway, 10~' Floor
Albany, NY 12233-5012
Re: AGENT # 1371
Town of Wappinger
SUPERVISOR
Barbara A. Gutzler
TOWN I30ARD
William l3. Beale
Vincent Bettina
Ismay Czarniecki
Michael Kuzmicz
Enclosed please find our recent Returnable Document. It is being forwarded
to you per DEC instructions. This occurred due to a printer error.
Sincerely,
Christine Fulton
Town Clerk
Town of Wappinger
CFljf
TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W~1'W.TOWNOFWAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-1478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
August 21, 2012
Revenue Accounting Unit
NYS Dept. of Conservation
625 Broadway, 10th Floor
Albany, NY 12233-5012
Re: AGENT # 13 71
Town of Wappinger
SUPERVISOR
Barbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Michael Kuzmicz
Enclosed please find our recent Returnable Document. It is being forwarded
to you per DEC instructions. This occurred due to a printer error.
Sincerely,
- - -~~~
Christine Fulton
Town Clerk
Town of Wappinger
CF/jf
Nicholas J Carlucci LIC~nSe
4S James Drive,
Putnam Valley NY 10579- ~Oj01/2012 ~
Valid ~ ,:
9!30/2013 _:.
0
_
04/09/1'.949 MGR 5-OS
*_ ~ zr
~
08121!2012 0
License~Privilege
= 3:09 PM
.~ ~I
Price
_
Res Sportsman + Fish 47.00 ~ ~m
0 ~'
MarineFieg 2013 01 %01:-12131 ~n~
0.0
=l Support Venison Donation T:.00 _g
~
-
~. J ~~N
c cm~
-
al
g
.46.00
- ° ooc#1331-soa>.•1esi3
Txn# 1331.700D•Fi821
- ~o~if 1331-6002-1 ~17C1 ~'a~`
2CI12-1 3 .~.
BEAR TALI-RES
:Nicholas J Carlucci 04/09/1949 ,~
°'
-
:
:
ID# 1935-8000-1170 Issued 08/211;_'01? 03:09 PM
Fill out both sides immediately Lipon har/e:~t ~""
~~~x rsn ^F ::
~
Date - -~rle ^AdultC]Cub
- __
aria
~.~
o County _ 7Regular Season ~ ;
°
1.
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:~
emu.
~Tovm ^Bowhunting °_'"•"-
.Muzzleloading _
WMU _ „
D~c;# 1331-6002-1 PI'691 ~y'
EASON DEER-RES
REG 201 2-1 3~~~M
Nicholas J Carlucoi 04!09/1949 ~_..
s
p.
a
iD# 1935-8000-1170 Issued 08/21!2012 03;09 PM ::.
Fill out both sides immediately N~Ipon harvest ~"
-~~
Date SE=.x ^M ^F'
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IIII ~~D ~ lOZ/ L0/0 L OL L L-0002-9E61 # 41
j ~~ IoonlaeD (' Sr;IO4~IN
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New York State Department of Environmental Conservation
Affidavit of Previous License
'~ /. ~ _ Please Print Legibly
I i ~,~ ~ ~, ~~-t--`~~-'~,'-- ,hereby afftrm under penalty of perjury that I have previously issued a
(Fu1 ame)
sporting license to f~Lc~,c~~eS ~~~~ es ~~~~,~~0 while acting as a License Issuing Officer for the
(Applicant Name and Date of Birth)
New York State Department of Environmental Conservation from the dates of: -~ to ~ U/ ~.
I may be contacted at the following telephone number if further information is required:
Please select the type of licenser you pre~%iously issued to the app`,
~F'~i..
licatit l;~~'~sf el~g "YES". Select "NO" if
-~' ~ r.. ~zn ,
you do not remember issuing tle:license type'`~"tl~e t1tCa~f~ J
!)1~,
r ~'.
r~
All license types MUST be-seed'ted - ~>: ::
4s ;' ';+~g,.
1. Hunting YES ' ~f ~' - , z u ,~~ ~ ~.• ~'. , ~YY
,~.
2. Bowh~'ti~~~ '
,?
t
3. Tra "~~ , . `.YES 'N?O ~ " , . _. ,,
=
x
(License Issuing icer Signature)
*Applicant Must Complete Prior to Purchase* ~'= ;°;
n,
I
I herebyaffirm under penalty of perjury that I ~~, ~ h ~ I0. ~ ~ ~~~ e
licant Name)
,:: (A ,~:
- previous -
pwchase~.a he " pp
?a` tom" d that the~ve informat~" -
' ~' ~ Y
(A~iph~8lt St (arts) ;'' ~ ~~" ~ ~ . , ~ `~ . ~~ ~ ~" .
__ r ,, ~ .. ~ ,,..
*Curi`~e~i%t Issuing Officer M~lst ~3o~ili3le'ie+~i`.5~ e* . ~ ~ ~`i"
~ ° ~ , ~3 -7
Affidavit accepted by~„~f 1%~~"~?-~~~.~,.~~ Xgent Ill. Nun`tber:
(3Jame of accepting Lica~e-]ssniifg~ C$BYC~s~~•' ,.,; ~~r r
vs ';'-'
~.
c~ ~-- :~-~---
{License Issuing Officer Signature)
*Issuing Agent must mail this affidavit to the address listed below within thirty (30) days of
license issuance:
NYSDEC License Sales
625 Broadway
Albany, New York 12233-4790
This is affidavit is proof of sportsman eligibility. This is NOT proof of successful completion of a
Sportsman Education Course.
r '
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
~ APPLICATION FOR A REPLACEMENT
CARCASS TAG
PRINT -Name (First, MI. Last)
/?-~ ~/ ~2t~i
S ~-~,- ~ l S t~ ~ ~ ~S) C~
Date of Birth: ly ~UI ~~U
Customer ID Number:
~ ~iCG3~0 ~D b ~
You MUST furnish the full 12-digit 1 D number that appears
on your origins! license.
Check type of residence: .~,1 Resident ^Nop-Resident
Check Type of License:
^ Big/ Small Game ^ Sportsman
^ Hunting (Small Game Only) ^ Super Sportsman
Check Item -Desired
(JS-(~ ~41-~OD-03~ ~ ~ ~ ~ ~
s~a+ a~-~s $ ~ ~ ~
~Or SSIIJp73J~i.7 IMwe 1Y~.7m+GISiW
j.iiwl, G,lii ~~
= ~ ~
i V
)
QQ
~+o.+ara ~I
~' ~
1 S
~WIIII MM ^o..r ~.
1111
1111YY
11 i
"'
0.
.
w.~ro wMO... L'IM Of ~
Dtruri.w~Ll.ra.rDw.rw.w.v ~I
~IIIIBIIIMNIIIIt~ ' •..~ •~
~'^ T"""'"' I NYSOEC
tO FUMrLwla
Ab^y Ny 74Lii ~ iWOt Q006
~
~OfAiHP51 MBL 6 ~rl0/1006
~
=Lp++N?ritip~ 1J,11INDlN»PU ~
Prq
~"" 6wonrnr^ 3~ ~
~
~
^ Non-Res Big Game ~iMuzzle
^ Legacy D Turkey
^ Back Tag - No Fee ^ Deer Carcassl Report - 510.00
^ Bear Carcass/ Report - $10.00
Specific circumstances under which the carcass tag was lost or destroyed:
Customer ID No. is
located on License/
Privilege Panel
under bar code.
(Not Document
No.)
~] Bow
^ Turkey Carcass/Report - $10.00
I hereby report that t lost or accidently destroyed the carcass tag/permit portion of the above license. I request that the department
issue a replacement tag/permit. I hereby affirm, under penalty of perjury and other appropriate provisions of the law, that no deer,
bear or wrkey was taken pursuant to this license. I further affirm that the carcass tag/permit was lost or destroyed as reported in this
application. If the ORIGINAL carcass tag/permit is found or recovered, I understand that I must surrender it immediately to the License
Issuing Agent which issued the duplicate.
I UNDERSTAND THAT GRATU{TOUSLY REPORTING TO A PUBLIC OFFICIAL OR AGENCY THE ALLEGED
OCCURRENCE OF AN INCIDENT, WHICH DID NOT IN FACT OCCUR, CONSTITUTES A CRIME PURSUANT TO THE
PENAL LAW. IN ADDITION, MAKING A FALSE STATEMENT IN APPLYING FOR A LICENSE, STAMP, OR PERMIT
UNDER THE ENVIRONMENTAL CONSERVATION LAW, OR FOR A CERTIFICATE IN LIEU OF A LOST OR
DESTROYED LICENSE, STAMP OR A DUPLICATE BIG GAME LICENSE TAG IS A MISDEMEANOR.
FOR ISSUING AGENT USE ONLY
Duplicate Issued By:
Agent: / 3 _' /
Address: r~7r~_?_rr"> ;~~ir~iy~~~h c~ r,/
1 ILI ~ t7~; ~~y2 `~ ir-r~ It C P-)~
Phone N~ber: ~S `~c c~ ~-I ~7~ /
By: ~ ~,~.~,~~~-~
's^
Date: / c-?~`~~a ~/ ~
Replacement Document(s) Number:
CERTIFICATION: I hereby affirm under penalty of penury that all the information provided on
this farm is true w the best of my knowle and ief, and that I am not apptying for a
Replacement Carcass Tag for which my re suspended or revoked. False statements
ere punishable as a Class A misde r Section 210.45 of the Penal Law.
G
Signs of Applicant
.~~ ~~~t a~~~a
Date
1L LI O: Reviews application for completeness and issues duplicate tag.
LIO must enter the original 12-digit Customer ID Number on the
replacement tag.
ISSUING AGENT MUST RETAIN THIS ORIGINAL SIGNED DOCUMENT ON FILE AND AVAILABLE FOR REVIEW
A7 THE REQUEST OF THE DEPARTMENT FOR THREE YEARS.
__
~~
PRINT -Name (First, Ml, La
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
APPLICATION FOR A REPLACEMENT
CARCASS TAG
~r `L C~ D ~~ --
~~~; ~, I~ ~~ ~ { ~- y 1z C ~ r
Date of Birth: `t- y -,~ 3
Customer ID Number:
a c / -
IYou MUST furnish the full 12-digit ID number that appear
on your original license.
'Check type of residence: •flf'Resident ^Non-Resident
Check Type of License:
^ Big/ Small Game I~Sportsman
^ Hunting (Small Game Only) ^ Super Sportsman
Check Item -Desired
CERTIFICATION: I hereby affirm under penalty of perjury that all the information provided on
this form is true to the best of trrgJcnowledge and belief, and that I am not applying for a
Replacement Caress Tag for,4vhich my privileges are suspended or revoked. False statements
are punishable as a Class A misdemeanor pursuanYto,Section 210.45 of the Penal Law.
Customer ID No. is
located on License/
Privilege Panel
under bar code.
(Not Document
^ Bow
^ Back Tag - No Fee CI, Deer Carcass! Report - $10.00 0"Furkey Carcass/Report - $10.00
^ Bear Carcass/ Report - $10.00
Specific circumstances under which the carcass tag was lost or destroyed: ' ~ ~,-E- .
l hereby report that I lost or accidenriy destroyed the carcass tag/permit portion of the above license. I request that the department
issue a replacement tag/permit. I hereby affirm, under penalty of perjury and other appropriate provisions of the law, that no deer,
bear or turkey was taken pursuant to this license. I further affirm that the carcass tag/permit was lost or destroyed as reported in this
application. If the ORIGINAL carcass tag/permit is found or recovered, I understand that I must surrender ft immediately to the License
Issuing Agent which issued the duplicate.
I UNDERSTAND THAT GRATUITOUSLY REPORTING TO A PUBLIC OFFICIAL OR AGENCY THE ALLEGED
OCCURRENCE OF AN INCIDENT, WHICH DID NOT IN FACT OCCUR, CONSTITUTES A CRIME PURSUANT TO THE
PENAL LAW. IN ADDITION, MAKING A FALSE STATEMENT IN APPLYING FOR A LICENSE, STAMP, OR PERMIT
UNDER THE ENVIRONMENTAL CONSERVATION LAW, OR FOR A CERTIFICATE IN LIEU OF A-LOST OR
DESTROYED LICENSE, STAMP OR A DUPLICATE BIG GAME LICENSE TAG IS A MISDEMEANOR.
FOR ISSUING AGENT USE ONLY
Duplicate Issued By:
Agent: _ 1 ~
Address: ~(~ 11'lI<1<'i~D ~~~I)
-~'~';°irt~~~G~-III ~.
Phone Number: ~~"N~l ~j~~~1'~~~ I
Date: 11' ~ ~ l '~
Time: ;~ ~. I ~~
Replacement Document(s) Number:
~~ ~S11-W00~03~ ~ ~ i ~ ~ ~
SI~011 LEEP,-fiES gl I ~
~o•ssr~ ~.,.a+a„am,wmw
~ s ~.
jam .
~~ ~
i
~TOw Nlrn
1~ p
+
~~
nw Pana_
or W.wny ...wa..DN Or
m
~
Otiwn swv, O.ar, Du w....a.a ~
°°°~ IIIIBiII®III~III~
..,,.,,.,
'°"" T"""" ! NYSDEC
zany Nv i~ Moroi coos
~ROti0MY9t MBL i _
Oo.9011006
~
=LiarrNrhirM~p~ ~0.WNOSM»PU _
_
PrRY O
!
iFIM Q07etMIW; {~
~i~. F i,
Ow ...
r. ~
o
am sr anr. 7777.00
~
-- ---- ---- r.r.~,,,.,,,,ar.,
^ Non-Res Big Game ^ Muzzle
^ Legacy ^ Turkey
Signature of Applicant
/~~ ~~ l
Date
LIO: Reviews application for completeness and issues duplicate tag.
LIO must enter the original 12-di it Customer ID N b h
g um er on t e
replacement tag.
ISSUING AGENT MUST RETAIN THIS ORIGINAL SIGNED DOCUMENT ON FILE AND AVAILABLE FOR REVIEW
AT THE REQUEST OF THE DEPARTMEIUT Fns? •rNV~c vice~c
TOWN CLERK
~ Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W.TOWNOFWAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-]478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
December 27,2012
Revenue Accounting Unit
NYS Dept. of Conservation
625 Broadway, 10th Floor
Albany, NY 12233-5012
Re: AGENT # 1371
Town of Wappinger
SUPERVISOR
Baxbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Michael Kuzmicz
Enclosed please find our recent Returnable Document. It is being forwarded
to you per DEC instructions. This occurred due to a printer error.
If you have any further questions please contact my office at (845) 297-5771
Sincerely,
Christine Fulton
Town Clerk
Town of Wappinger
CFIJ F
TOWN OF WAPPINGER
TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W .TOWNOFW APPINGER.US
(845) 297-4158 -Main
(845) 29?-5771 -Direct
(845) 298-1478 -Fax
Office of the Town Clerk
November 19, 2012
Revenue Accounting Unit
NYS Dept. of Conservation
625 Broadway, 10~' Floor
Albany, NY 12233-5012
Re: AGENT # 13 71
Town of Wappinger
SUPERVISOR
Barbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Michael I~uzmicz
My office has been informed through the New York DECALS messaging
system that it will be charged for a returnable document that was not
returned in July. Enclosed please find a copy of the July 27~' Returnable
Document letter. that was sent to your office. This is the only Returnable
Document not accounted for in your system and the only document we have
record of for the month of July. Also enclosed is a copy of the License Sales
Agent Receipt and Shift Report for that same day. The customer only left
this office with one Residential Fishing Season License, the other was
returned to you, as you can see by the documents enclosed. I will expect that
this is sufficient evidence that I will not be charged for the Returnable
Document.
If you have any further questions please contact my office at (845) 297-5771
Sincerely,
Christine Fulton
Town Clerk
Town of Wappinger
CF
I TOWN CLERK
Christine Fulton
20 MII7DLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W.TOW N OF W APPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-1478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
July 27, 2012
Revenue Accounting Unit
NYS Dept. of Conservation
625 Broadway, 10~' Floor
Albany, NY 12233-5012
Re: AGENT # 1371
Town of Wappinger
SUPERVISOR
Barbara A Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czamiecki
Michael l:uzmicz
Enclosed please find our recent Returnable Document. It is being forwarded
to you per DEC instructions. This occurred due to a printer error.
Sincerely,
_ ~~
Christine Fulton
Town Clerk
Town of Wappinger
CF/jf
___
._.,
-- -__ _.
__ - ----1
r~ t~iac Its
~~ SALES
Shift
' ~* ~-i~d ~n; o7r~~~1~ a3:~s Pri ~r
i ~~~~
i ~ M-I RGgD y
;~
4~PI}~ FALL,, ~,' - 1~
~ Cl ~ t am ~ cfui ton
Report For tine .Date : a7/Z72a1 ~
Sa) es'
P05 ID Transaotinn Aims- pay mount
1331 133I7aaa577c CA x.00
1~1 13317 CAA x.00
' - 1331 -Total ~9,pp
Clerk's Tots} Saes ~~
i
Sales Distribution By Pay~rent I"~thod
Code ~a-i pti on
~ l~nurtt
CIS, ~, S29.LYJ
~ Credit Card ~. a~0
~ ~ I~bi t Card .~CKi.00
Tota} &'5.00
r
~ yam( IlQ~L5
LIB S~
Returnable Docunents import as of
11/i9/c~l~
report printed on. 11(13;i~~1S %9:cG rN'1 EST
p~ ID ' 1371
~~I LFV~_~ F~}f ~y; '~` iLJ~~
Transaction hknt~er' Voided Doc ID
Description Ism Date
Voided Date
~~17~,~;~~ 1331E~C~031b1`3
:Res F, shi ng season ':i?i c !cC~l c
D
G1_
C,?r c~'?~;}1c . Cu
~~
i;~1?i~C~;'~%S 1~1i~Cic161~
Dor_ : P`I~'~ n~teg c012 ~J7, ~r`cC?1 c
C~11'?I~il~ ~C~,~.CiU
13317Ci~t~`+~ 1331 ~"x~'?
Doc
Reshlu~~l eLoadi ngrtana^3en1GrC~r3C~1
for
10/C9i cQ13 ~~'
1' ~17C>~~~ 1~i6~:,~
Doc :Res $~unting
~~ r,
St -Senior 1C~/(~3:f"c!1~..
it)iC_1c~1S ~~°~'
1331?~:~~r-!5a~t~' 1~1~c~. ~'
P,oc : P~arineReg SU13 1Q!(?3rc01~OU.~
13317Ut~C~+` 1331 GCikc''~?
Doc ' i"tarineReg plc 1%;~/(1JI~t?lc
13;1?tr ~~=j~ i331h~!G.L~`~~~~
L o ~ p i ter Se;.
LARC~1`k; Tr~G 10,/f~,%"`01 c
1 C;r C~I~=Ca13 ~~~. C~)
13J17t~~:;5'~+S 13310-~0~''`~~.9
Antl erl ess I~R ~~::;
TAG ~ ~3 L
1C%,.~/ct.1-
1G1Q9/cQlz ~tiO.~J~J
i erl ess ~ i~'.
TAG lt~i G~,'~C1 ~
.
1 ~% ~J9"i201 c .
~~~~
!3317t~C~~#L 1:~1~Otkc~r~1.
17EFR o$ Ei t!ier Sex
1
TOWN CLERK
Christine Fulton
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
W W W.TOWNOF WAPPINGER.US
(845) 297-4158 -Main
(845) 297-5771 -Direct
(845) 298-]478 -Fax
TOWN OF WAPPINGER
Office of the Town Clerk
Apri13, 2012
Revenue Accounting Unit
NYS Dept. of Conservation
625 Broadway, 10th Floor
Albany, NY 12233-5012
Re: AGENT # 1371
Town of Wappinger
SUPERVISOR
Barbara A. Gutzler
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czarniecki
Michael Kuzmicz
Enclosed please find a copy of the agent receipt containing a voided
transaction and all returnable documents. It is being forwarded to you per
DEC instructions. This occurred due to the fact that the customer changed
their mind. The license Sportsman license was voided and a fishing license
was reissued the same day.
Sincerely,
~, _.~
Christine Fulton
Town Clerk
Town of Wappinger
PB,J YI~K I)FI'A1.5
LIf~ ~l6
Aga~t Receipt
I1fiTE : 07127/c~D12 10:49:02 EST
TRXN ND :133170005712
PGENT ID :1371
POS ID :1331
CLD~K ID : cful ton
PAYh1hM TOPE :CASH
Li~see :Ronald Shields
CL15T ID : 133180t}01551
DOC# : 133160t~16i8
ITEM YR QTY At~1lM j
006-Res Fishing Season 12 1 X29.00
2~-MarinePeg 2012 12 1 ~O.QO ~
TOTAL : s29.oo
1141E :07127/2012 10:49:02 E5T
TR?W NO : 133170005773
AGENT ID :1311
P(~, TD :1331
CLERK ID : cfulton
PAYi~1rM TYPE :CASH j
Licensee :Ronald Shields ~
C1JST ID :133180401551
DOC# :133160421618
ITET1 YR QTY
006-Res Fishing Season 12 1 ~-c~.00
2r'~-fYkri nsReg c'~12 12 1 `i0.00
~~ : ~ 29.00
5
`y,~~' 9
1MY\
LIB SALES
Agent Receipt
I1ATE : 07/1/2012 10:53:22 E5T