1. Please print your Customer ID or driver license number or social security number AND date of birth. Customer ID No. Or Driver License No. Or Social Security No. AND Date of Birth 2. Please print your name. MM / DD / YYYY Phase I APPLICATION PERIODS All periods begin at 10:00 a.m. Eastern time and end at 11:59 p.m. Eastern time September 14, 2018 - September 24, 2018 Permit Pickup Deadline: October 08, 2018 Phase II October 11, 2018 - January 14, 2019 First Middle Last 3. Please indicate your 4-digit hunt choice(s) (# that appears to the left of each hunt) in the boxes provided. 1st Choice 2nd Choice 3rd Choice 4th Choice 5th Choice 4. You can apply online at http://gooutdoorsflorida.com (choose 'Apply for Limited Entry/Quota Permits') or you can complete this form and present it to any license agent or tax collector office and they will submit your application for you. Submitting false information or using another person s identity without their consent is considered identity theft and may result in felony charges and the loss of hunting privileges. The Florida Fish and Wildlife Conservation Commission (FWC) collects social security numbers (SSN) for the issuance of recreational and professional fishing or hunting licenses or permits to an individual in accordance with chapter 379 F.S. and 42 USC 666 for the purposes of administration of the Title IV-D program for child support enforcement, use by the Commission, and as otherwise provided by law. FOR AGENT USE ONLY To Submit an Application: INSTRUCTIONS FOR TAX COLLECTOR OFFICES AND LICENSE AGENTS In RLIS, navigate to the Customer Lookup Screen and enter the customer s date of birth and customer ID number, Florida Driver s License number, or the last four digits of the customer s Social Security Number and last name. Under the Customer s Detail section, select Apply for Limited Entry/Quota. Choose the appropriate application and proceed through with prompts according to the customer's requests. Verify all permit choice information before submitting, and print document receipt for the customer.
2100 Catfish Creek Impoundment November 17-18, 2018 5 $ 27.50 2101 Catfish Creek Impoundment November 21-22, 2018 5 $ 27.50 2102 Catfish Creek Impoundment November 24-25, 2018 5 $ 27.50 2103 Catfish Creek Impoundment December 8-9, 2018 5 $ 27.50 2104 Catfish Creek Impoundment December 12, 2018 5 $ 27.50 2105 Catfish Creek Impoundment December 15-16, 2018 5 $ 27.50 2106 Catfish Creek Impoundment December 19, 2018 5 $ 27.50 2107 Catfish Creek Impoundment December 22-23, 2018 5 $ 27.50 2108 Catfish Creek Impoundment December 25-26, 2018 5 $ 27.50 2109 Catfish Creek Impoundment December 29-30, 2018 5 $ 27.50 2110 Catfish Creek Impoundment January 1-2, 2019 5 $ 27.50 2111 Catfish Creek Impoundment January 5-6, 2019 5 $ 27.50 2112 Catfish Creek Impoundment January 09, 2019 5 $ 27.50 2113 Catfish Creek Impoundment January 12-13, 2019 5 $ 27.50 2114 Catfish Creek Impoundment January 16, 2019 5 $ 27.50 2115 Catfish Creek Impoundment January 19-20, 2019 5 $ 27.50 2116 Catfish Creek Impoundment January 23, 2019 5 $ 27.50 2117 Catfish Creek Impoundment January 26-27, 2019 5 $ 27.50 2200 Gator Creek Impoundment November 17-18, 2018 3 $ 27.50 2201 Gator Creek Impoundment November 21-22, 2018 3 $ 27.50 2202 Gator Creek Impoundment November 24-25, 2018 3 $ 27.50 2203 Gator Creek Impoundment December 8-9, 2018 3 $ 27.50 2204 Gator Creek Impoundment December 12, 2018 3 $ 27.50 2205 Gator Creek Impoundment December 15-16, 2018 3 $ 27.50 2206 Gator Creek Impoundment December 19, 2018 3 $ 27.50 2207 Gator Creek Impoundment December 22-23, 2018 3 $ 27.50 2208 Gator Creek Impoundment December 25-26, 2018 3 $ 27.50 2209 Gator Creek Impoundment December 29-30, 2018 3 $ 27.50 2210 Gator Creek Impoundment January 1-2, 2019 3 $ 27.50 2211 Gator Creek Impoundment January 5-6, 2019 3 $ 27.50 2212 Gator Creek Impoundment January 09, 2019 3 $ 27.50 2213 Gator Creek Impoundment January 12-13, 2019 3 $ 27.50 2214 Gator Creek Impoundment January 16, 2019 3 $ 27.50 2215 Gator Creek Impoundment January 19-20, 2019 3 $ 27.50 2216 Gator Creek Impoundment January 23, 2019 3 $ 27.50 2217 Gator Creek Impoundment January 26-27, 2019 3 $ 27.50 2300 Peacock's Pocket Impoundment November 17-18, 2018 10 $ 27.50 2301 Peacock's Pocket Impoundment November 21-22, 2018 10 $ 27.50 2302 Peacock's Pocket Impoundment November 24-25, 2018 10 $ 27.50 2303 Peacock's Pocket Impoundment December 8-9, 2018 10 $ 27.50 2304 Peacock's Pocket Impoundment December 12, 2018 10 $ 27.50 2305 Peacock's Pocket Impoundment December 15-16, 2018 10 $ 27.50 2306 Peacock's Pocket Impoundment December 19, 2018 10 $ 27.50
2307 Peacock's Pocket Impoundment December 22-23, 2018 10 $ 27.50 2308 Peacock's Pocket Impoundment December 25-26, 2018 10 $ 27.50 2309 Peacock's Pocket Impoundment December 29-30, 2018 10 $ 27.50 2310 Peacock's Pocket Impoundment January 1-2, 2019 10 $ 27.50 2311 Peacock's Pocket Impoundment January 5-6, 2019 10 $ 27.50 2312 Peacock's Pocket Impoundment January 09, 2019 10 $ 27.50 2313 Peacock's Pocket Impoundment January 12-13, 2019 10 $ 27.50 2314 Peacock's Pocket Impoundment January 16, 2019 10 $ 27.50 2315 Peacock's Pocket Impoundment January 19-20, 2019 10 $ 27.50 2316 Peacock's Pocket Impoundment January 23, 2019 10 $ 27.50 2317 Peacock's Pocket Impoundment January 26-27, 2019 10 $ 27.50 2400 L Pond Impoundment November 17-18, 2018 7 $ 27.50 2401 L Pond Impoundment November 21-22, 2018 7 $ 27.50 2402 L Pond Impoundment November 24-25, 2018 7 $ 27.50 2403 L Pond Impoundment December 8-9, 2018 7 $ 27.50 2404 L Pond Impoundment December 12, 2018 7 $ 27.50 2405 L Pond Impoundment December 15-16, 2018 7 $ 27.50 2406 L Pond Impoundment December 19, 2018 7 $ 27.50 2407 L Pond Impoundment December 22-23, 2018 7 $ 27.50 2408 L Pond Impoundment December 25-26, 2018 7 $ 27.50 2409 L Pond Impoundment December 29-30, 2018 7 $ 27.50 2410 L Pond Impoundment January 1-2, 2019 7 $ 27.50 2411 L Pond Impoundment January 5-6, 2019 7 $ 27.50 2412 L Pond Impoundment January 09, 2019 7 $ 27.50 2413 L Pond Impoundment January 12-13, 2019 7 $ 27.50 2414 L Pond Impoundment January 16, 2019 7 $ 27.50 2415 L Pond Impoundment January 19-20, 2019 7 $ 27.50 2416 L Pond Impoundment January 23, 2019 7 $ 27.50 2417 L Pond Impoundment January 26-27, 2019 7 $ 27.50 2500 M Pond Impoundment November 17-18, 2018 4 $ 27.50 2501 M Pond Impoundment November 21-22, 2018 4 $ 27.50 2502 M Pond Impoundment November 24-25, 2018 4 $ 27.50 2503 M Pond Impoundment December 8-9, 2018 4 $ 27.50 2504 M Pond Impoundment December 12, 2018 4 $ 27.50 2505 M Pond Impoundment December 15-16, 2018 4 $ 27.50 2506 M Pond Impoundment December 19, 2018 4 $ 27.50 2507 M Pond Impoundment December 22-23, 2018 4 $ 27.50 2508 M Pond Impoundment December 25-26, 2018 4 $ 27.50 2509 M Pond Impoundment December 29-30, 2018 4 $ 27.50 2510 M Pond Impoundment January 1-2, 2019 4 $ 27.50 2511 M Pond Impoundment January 5-6, 2019 4 $ 27.50 2512 M Pond Impoundment January 09, 2019 4 $ 27.50 2513 M Pond Impoundment January 12-13, 2019 4 $ 27.50 2514 M Pond Impoundment January 16, 2019 4 $ 27.50 2515 M Pond Impoundment January 19-20, 2019 4 $ 27.50
2516 M Pond Impoundment January 23, 2019 4 $ 27.50 2517 M Pond Impoundment January 26-27, 2019 4 $ 27.50 2600 Shiloh 1 Impoundment November 17-18, 2018 5 $ 27.50 2601 Shiloh 1 Impoundment November 21-22, 2018 5 $ 27.50 2602 Shiloh 1 Impoundment November 24-25, 2018 5 $ 27.50 2603 Shiloh 1 Impoundment December 8-9, 2018 5 $ 27.50 2604 Shiloh 1 Impoundment December 12, 2018 5 $ 27.50 2605 Shiloh 1 Impoundment December 15-16, 2018 5 $ 27.50 2606 Shiloh 1 Impoundment December 19, 2018 5 $ 27.50 2607 Shiloh 1 Impoundment December 22-23, 2018 5 $ 27.50 2608 Shiloh 1 Impoundment December 25-26, 2018 5 $ 27.50 2609 Shiloh 1 Impoundment December 29-30, 2018 5 $ 27.50 2610 Shiloh 1 Impoundment January 1-2, 2019 5 $ 27.50 2611 Shiloh 1 Impoundment January 5-6, 2019 5 $ 27.50 2612 Shiloh 1 Impoundment January 09, 2019 5 $ 27.50 2613 Shiloh 1 Impoundment January 12-13, 2019 5 $ 27.50 2614 Shiloh 1 Impoundment January 16, 2019 5 $ 27.50 2615 Shiloh 1 Impoundment January 19-20, 2019 5 $ 27.50 2616 Shiloh 1 Impoundment January 23, 2019 5 $ 27.50 2617 Shiloh 1 Impoundment January 26-27, 2019 5 $ 27.50 2700 Shiloh 2 Impoundment November 17-18, 2018 3 $ 27.50 2701 Shiloh 2 Impoundment November 21-22, 2018 3 $ 27.50 2702 Shiloh 2 Impoundment November 24-25, 2018 3 $ 27.50 2703 Shiloh 2 Impoundment December 8-9, 2018 3 $ 27.50 2704 Shiloh 2 Impoundment December 12, 2018 3 $ 27.50 2705 Shiloh 2 Impoundment December 15-16, 2018 3 $ 27.50 2706 Shiloh 2 Impoundment December 19, 2018 3 $ 27.50 2707 Shiloh 2 Impoundment December 22-23, 2018 3 $ 27.50 2708 Shiloh 2 Impoundment December 25-26, 2018 3 $ 27.50 2709 Shiloh 2 Impoundment December 29-30, 2018 3 $ 27.50 2710 Shiloh 2 Impoundment January 1-2, 2019 3 $ 27.50 2711 Shiloh 2 Impoundment January 5-6, 2019 3 $ 27.50 2712 Shiloh 2 Impoundment January 09, 2019 3 $ 27.50 2713 Shiloh 2 Impoundment January 12-13, 2019 3 $ 27.50 2714 Shiloh 2 Impoundment January 16, 2019 3 $ 27.50 2715 Shiloh 2 Impoundment January 19-20, 2019 3 $ 27.50 2716 Shiloh 2 Impoundment January 23, 2019 3 $ 27.50 2717 Shiloh 2 Impoundment January 26-27, 2019 3 $ 27.50 2800 Shiloh 3 Impoundment November 17-18, 2018 5 $ 27.50 2801 Shiloh 3 Impoundment November 21-22, 2018 5 $ 27.50 2802 Shiloh 3 Impoundment November 24-25, 2018 5 $ 27.50 2803 Shiloh 3 Impoundment December 8-9, 2018 5 $ 27.50 2804 Shiloh 3 Impoundment December 12, 2018 5 $ 27.50 2805 Shiloh 3 Impoundment December 15-16, 2018 5 $ 27.50 2806 Shiloh 3 Impoundment December 19, 2018 5 $ 27.50
2807 Shiloh 3 Impoundment December 22-23, 2018 5 $ 27.50 2808 Shiloh 3 Impoundment December 25-26, 2018 5 $ 27.50 2809 Shiloh 3 Impoundment December 29-30, 2018 5 $ 27.50 2810 Shiloh 3 Impoundment January 1-2, 2019 5 $ 27.50 2811 Shiloh 3 Impoundment January 5-6, 2019 5 $ 27.50 2812 Shiloh 3 Impoundment January 09, 2019 5 $ 27.50 2813 Shiloh 3 Impoundment January 12-13, 2019 5 $ 27.50 2814 Shiloh 3 Impoundment January 16, 2019 5 $ 27.50 2815 Shiloh 3 Impoundment January 19-20, 2019 5 $ 27.50 2816 Shiloh 3 Impoundment January 23, 2019 5 $ 27.50 2817 Shiloh 3 Impoundment January 26-27, 2019 5 $ 27.50 2900 Shiloh 5 Impoundment November 17-18, 2018 7 $ 27.50 2901 Shiloh 5 Impoundment November 21-22, 2018 7 $ 27.50 2902 Shiloh 5 Impoundment November 24-25, 2018 7 $ 27.50 2903 Shiloh 5 Impoundment December 8-9, 2018 7 $ 27.50 2904 Shiloh 5 Impoundment December 12, 2018 7 $ 27.50 2905 Shiloh 5 Impoundment December 15-16, 2018 7 $ 27.50 2906 Shiloh 5 Impoundment December 19, 2018 7 $ 27.50 2907 Shiloh 5 Impoundment December 22-23, 2018 7 $ 27.50 2908 Shiloh 5 Impoundment December 25-26, 2018 7 $ 27.50 2909 Shiloh 5 Impoundment December 29-30, 2018 7 $ 27.50 2910 Shiloh 5 Impoundment January 1-2, 2019 7 $ 27.50 2911 Shiloh 5 Impoundment January 5-6, 2019 7 $ 27.50 2912 Shiloh 5 Impoundment January 09, 2019 7 $ 27.50 2913 Shiloh 5 Impoundment January 12-13, 2019 7 $ 27.50 2914 Shiloh 5 Impoundment January 16, 2019 7 $ 27.50 2915 Shiloh 5 Impoundment January 19-20, 2019 7 $ 27.50 2916 Shiloh 5 Impoundment January 23, 2019 7 $ 27.50 2917 Shiloh 5 Impoundment January 26-27, 2019 7 $ 27.50 3100 East Gator Creek Impoundment November 17-18, 2018 4 $ 27.50 3101 East Gator Creek Impoundment November 21-22, 2018 4 $ 27.50 3102 East Gator Creek Impoundment November 24-25, 2018 4 $ 27.50 3103 East Gator Creek Impoundment December 8-9, 2018 4 $ 27.50 3104 East Gator Creek Impoundment December 12, 2018 4 $ 27.50 3105 East Gator Creek Impoundment December 15-16, 2018 4 $ 27.50 3106 East Gator Creek Impoundment December 19, 2018 4 $ 27.50 3107 East Gator Creek Impoundment December 22-23, 2018 4 $ 27.50 3108 East Gator Creek Impoundment December 25-26, 2018 4 $ 27.50 3109 East Gator Creek Impoundment December 29-30, 2018 4 $ 27.50 3110 East Gator Creek Impoundment January 1-2, 2019 4 $ 27.50 3111 East Gator Creek Impoundment January 5-6, 2019 4 $ 27.50 3112 East Gator Creek Impoundment January 09, 2019 4 $ 27.50 3113 East Gator Creek Impoundment January 12-13, 2019 4 $ 27.50 3114 East Gator Creek Impoundment January 16, 2019 4 $ 27.50 3115 East Gator Creek Impoundment January 19-20, 2019 4 $ 27.50
3116 East Gator Creek Impoundment January 23, 2019 4 $ 27.50 3117 East Gator Creek Impoundment January 26-27, 2019 4 $ 27.50