WILDLIFE CONSERVATION HUNT/FISH HARVEST

This Harvest Check-In is submitted for the purpose of hunting or fishing on Osage Nation property. This form must be completed and be returned to 102 Midland Street, Pawhuska, OK 74056 or submitted online. Please contact Cameron Chesbro at 918-287-5333 for more information or questions. Information provided aides in the management, protection, and conservation of species within the Osage Nation.

Name Name First Last
Date of Birth Date of Birth / MM / DD YYYY
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Drivers License Number (provide issuing state)
Wildlife Conservation Hunt/Fish License Number
Please answer the following questions:

This is the description of your section break.
Animal Harvested?
Gender of Animal?

Gender of Animal? Male Female
Identifying Characteristics? (Number of points on right and left side, beard length on turkey)
Date of Harvest Date of Harvest / MM / DD YYYY
Time of Harvest Time of Harvest : HH MM AM/PM
Harvest Method?

Harvest Method? Bow Muzzleloader Shotgun Rifle
Upload Picture

Attach Files
Property Location
Please Identify the location and/or Osage Nation property on which the hunting and dishing activities occurred.

This is the description of your section break.
Osage Nation Ranch (LEASE REFERENCE)
Osage Nation Owned Property (LEASE REFERENCE)
Other: (PLEASE SPECIFY)
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Email

WILDLIFE CONSERVATION HUNT/FISH HARVEST

WILDLIFE CONSERVATION HUNT/FISH HARVEST

Please answer the following questions:

Property Location Please Identify the location and/or Osage Nation property on which the hunting and dishing activities occurred.

Property Location
Please Identify the location and/or Osage Nation property on which the hunting and dishing activities occurred.