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2. 

3. Board of Trustees of the Freeholders and
   Commonalty of the Town of Southampton

    240 West Montauk Highway, Hampton Bays, NY 11946

   TRUSTEES OFFICE PHONE: 631-287-5717
   www.southamptontownny.gov/trustees

5. Please complete the online form to request a Waterfowl Permit Inspection
7. Date
   Date
8. Permit # (Provide multiple permit numbers if necessary)
9. Type of Blind (Check multiple if necessary)

   1. Floating Duck Blind
   2. Duck Boat: ADDITIONAL STEP: It is necessary to contact Marine Patrol at 631-702-2268 alongside submitting this form to inform them of your active hunting with your duck boat, and Marine Patrol will come to inspect.
   3. Stake Blind
   4. Shore Blind
   5. Other (please list in comments field)
11. First Name*
12. Last Name*
14. Email Address*
16. Contact Phone Number*
20. Comments
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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