Application for Permit and Hunting License: Your personal information is considered CONFIDENTIAL and is used only to obtain our Permit and Hunting License. This information is then shredded.
Or with the party of:
have voluntarily provided this personal information to Samson’s Ridge to obtain the necessary Permits for Hunting, on this day of
This information may be placed on file for further use of obtaining necessary permits for the purpose of hunting at Samson’s Ridge. ______(initial)
OR I oppose of my personal information being kept on file for further use. ______(initial)
I request this information be destroyed after obtaining necessary permit.
Len Rudd, Owner • 5156 Old Marion Road • Metropolis, IL 62960-3527
Office: 618-524-8977 • fax: 618-524-9837 • Cell: 270-994-2553