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Landowner or occupier Permission for Recreational Hunting

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					                                                             LANDOWNERS/OCCUPIERS                                                                 ACT Firearms Registry
                                                                 PERMISSION FOR                                                                          Use Only
                                                                                                                                               Licence Number:
                                                              RECREATIONAL HUNTING
                                                                         ACT Firearms Act 1996 - Table 61


                 Australian Capital Territory
                              Firearms Registry
               Submit this form with your firearm licence application, if your genuine reason is Recreational Hunting/Vermin Control and you will be shooting on
                                                                               someone else’s land.

    APPLICANT DETAILS
       ADULT FIREARMS                    LICENCE APPLICATION
      You are required to provide 100 points of identity with your application for a
 Firearms licence numbernew licence under this Act.
                                                                                                                                             Date of Birth

 Surname
    1.          APPLICANT DETAILS                                      Please Use
       BLOCK LETTERS in dark pen only.                                                                                                  dd      mm          yyyy
 Given Name(s)

      To be completed by
      The applicant / this
    LANDOWNER forOCCUPIER DETAILS
       Licence.                                                                                                                     Are you the:
       Surname

    Given Name(s)                                                                                                                   Landowner                Occupier

    PROPERTY ADDRESS
                                                                                                                                     Property Size     (minimum 50 acres)

 Street Number
                                                                                                                                     Acres
 Street Name
                                                                                                                               Hectares
 Suburb/Shire/Parish
                                                                                                                              You must provide evidence of the size of the
                                                                                          Post Code                           property and the landowner/occupier’s details
 State                                                                                                                        eg: Rates Notice, Utilities Notice.

     RESIDENTIAL ADDRESS              (If different from above)

                                                                                                                                          Home phone number
    Street Number

    Street Name

    Suburb                                                                                                                                 Work phone number

    State                                                                                 Post Code


                                                                                                                                           Mobile phone number

    E-mail
             Family Name


     PERMISSION TO DISCHARGE REGISTERED FIREARMS ON PRIVATE PROPERTY

I                                                                      (Landowner/occupier)     of                                                                   (Address)


Hereby grant                                                                          (Applicants name)   Permission to discharge registered firearms on my

property from                                 (Start Date)        to                            (End Date) Permission may be granted for a single day if required.


For the purposes of hunting/controlling the following prey:


                  Pig                            Goat                           Feral Cat                    Feral Dog

                  Dingo                          Brumby                         Camel                        Donkey

                  Rabbit                         Hare                           Fox                          Other




              Signature of landowner/occupier                                       dd        mm            yyyy

AFP 3014 (1/09)                                              AF2009-15 Approved form under ACT Firearms Act 1996 s271

				
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Description: Landowner or occupier Permission for Recreational Hunting