Code. WHITE. GREEN. 19. 1. 20. 2. 21. 3. 22. 4. 23. 5. 24. 6. 25. 7. 26. 8. 9. STURGEON RELEASED - NO REWARD DISK PRESEN
California Natural Resources Agency
FOR DEPARTMENT USE ONLY
DEPARTMENT OF FISH AND WILDLIFE 2017 STURGEON FISHING REPORT CARD AFFIDAVIT
Original document number ______________________ CDFW Office / Date received ___________/___________ Date keyed / Initials _______________/______________
INSTRUCTIONS: To report a lost or destroyed Sturgeon Fishing Report Card, submit this completed affidavit to a California Department of Fish and Wildlife (CDFW) office. The Affidavit must be received by a CDFW office listed on back by January 31, 2018 to meet the harvest reporting deadline. If purchasing a Duplicate Sturgeon Fishing Report Card, the affidavit must be submitted at the time of purchase. If you are purchasing a duplicate to replace a lost or destroyed report card, you must pay the $15.45 duplicate fee. If you are using this form to report your harvest only, then no duplicate fee is required. DMV/STATE ID NUMBER
STATE
GO ID NUMBER (FROM ALDS ISSUED LICENSE)
FIRST NAME
M.I.
LAST NAME
RESIDENCE ADDRESS CITY
STATE
DAY TELEPHONE
ZIP CODE
E-MAIL ADDRESS
To the best of your recollection, write the catch records that were entered on the original report card in the table below. Location codes are listed on the back of this form. WHITE STURGEON RETAINED Month
Day
Location Code
Length
STURGEON RELEASED - NO REWARD DISK PRESENT (Cont.) Reward Disk # (if present)
Month
1
14
2
15
3
16
Day
Location Code
WHITE
GREEN
17 STURGEON RELEASED - NO REWARD DISK PRESENT Month
Day
Location Code
WHITE
GREEN
18 19
1
20
2
21
3
22
4
23
5
24
6
25
7
26
8 9
STURGEON RELEASED - NO REWARD DISK PRESENT
10
Month
11
1
12
2
13
3
Day
Location Code
WHITE
GREEN
Describe the factual circumstances surrounding the loss or destruction of the report card here:
I hereby certify under penalty of perjury that I applied for and paid the fee for a 2017 Sturgeon Fishing Report Card. I further certify that I have not loaned, destroyed, or disposed of the said Sturgeon Fishing Report Card and I have completed a diligent search to ensure that said document was, in fact, lost. SIGNATURE (Must be signed in ink) DATE
X INSTRUCTIONS FOR CLERK 1. Write document number of original report card in Department Use box in upper right corner. 2. Remove and void the number of tags for sturgeon taken on original report card and staple them to the affidavit. 3. Transfer harvest data from the original report card to the Duplicate Report Card. Draw a line below the last entry indicating data that was reported on affidavit. If no sturgeon were taken, write “no sturgeon taken on previous report card”. 4. Place original affidavit in sales reconciliation, and mail a copy of affidavit and tags to the Stockton office, attention “Sturgeon Program”. FG304 (Rev.02/17)
CALIFORNIA DEPARTMENT OF FISH AND WILDLIFE OFFICES www.wildlife.ca.gov EUREKA - 619 Second Street, Eureka, CA 95501 (707) 445-6493 FRESNO - 1234 E. Shaw Avenue, Fresno, CA 93710 (559) 243-4005 LOS ALAMITOS - 4665 Lampson Avenue, Suite C, Los Alamitos, CA 90720 (562) 342-7100 MONTEREY - 20 Lower Ragsdale Drive, Suite 100, Monterey, CA 93940 (831) 649-2870 NAPA - 7329 Silverado Trail, Napa, CA 94558 (707) 944-5500 RANCHO CORDOVA - 1701 Nimbus Road, Rancho Cordova, CA 95670 (916) 358-2900 REDDING - 601 Locust Street, Redding, CA 96001 (530) 225-2300 SACRAMENTO - License and Revenue Branch, 1740 N. Market Blvd., Sacramento, CA 95834 (916) 928-5805 SAN DIEGO - 3883 Ruffin Road, San Diego, CA 92123 (858) 467-4201 STOCKTON – 2109 Arch Airport Road, Suite 100, Stockton, CA 95206 (209) 234-3420
LOCATION CODES
LOCATION CODES (cont.)
01A.
Sacramento River: Upstream of Red Bluff
13.
San Joaquin River: HWY 140 bridge to Stockton
01B.
Sacramento River: Red Bluff to Hwy 32 bridge
14.
San Joaquin River: Stockton to Sherman Lake
01C.
Sacramento River: Hwy 32 bridge to Colusa
15.
Old River
02.
Sacramento River: Colusa to Knights Landing
16.
San Pablo Bay
03.
Sacramento River: Knights Landing to Rio Vista
17.
Carquinez Strait
04.
Sacramento River: Rio Vista to Chipps Island
18.
Suisun Bay
05.
Feather River
19.
Grizzly Bay
06.
American River
20.
San Francisco Bay: North of HWY 80
07.
Sacramento Deepwater Ship Channel
21.
San Francisco Bay: South of HWY 80
08.
Yolo Bypass
22.
Pacific Ocean: North of Golden Gate Bridge
09.
Montezuma Slough
23.
Pacific Ocean: Golden Gate Bridge to Point Sur
10.
Napa River
24.
Pacific Ocean: Point Sur to San Diego
11.
Petaluma River
25.
Any reservoir or lake
12.
San Joaquin River: Upstream of HWY 140 bridge
26.
Klamath River
