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ORDER FOR BACK YEAR STAMPS
State Form 42879 (R8 / 11-01) Approved by the State Board of Accounts, 2001

Please Mail To:

DNR - Fish and Wildlife "STAMPS" 402 West Washington Street, Room W273 Indianapolis, Indiana 46204-2267 Include a self-addressed stamped envelope and allow 4 to 6 weeks for delivery.

Name of purchaser

Telephone number

(
Address (number and street or rural route, city, state, ZIP code)

)

Quantity

MIGRATORY WATERFOWL STAMPS Description Price Each 1976 Green-winged Teal 1977 Pintail 1978 Canada Goose 1979 Canvasback 1980 Mallard Ducklings 1981 Hooded Merganser 1982 Blue-winged Teal 1983 Snow Goose 1984 Redheads 1985 Pintail 1986 Wood Duck 1987 Canvasback 1988 Redheads 1989 Canada Goose 1990 Blue-winged Teal 1991 Mallards 1992 Green-winged Teal 1993 Wood Ducks 1994 Pintail 1995 Common Goldeneyes 1996 Black Ducks 1997 Canada Geese 1998 American Widgeon 1999 Bluebills 2000 Ring-necked Ducks 2001 Hooded Merganser *2002 Green-winged Teal **2003 Shovler Ducks $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $

TROUT / SALMON STAMPS Amount Quantity Description 1967 Trout (Line Art) 1968 Trout (Line Art) 1969 Trout (Line Art) 1976 Trout (Line Art) 1977 Brown Trout 1978 Chinook Salmon 1979 Rainbow Trout 1980 Brook Trout 1981 Lake Trout 1982 Rainbow Trout 1983 Brook Trout 1984 Rainbow Trout 1985 Steelhead Trout 1986 Lake Trout 1987 Brown Trout 1988 Lake Trout 1989 Brown Trout 1990 Brook Trout 1991 Brown Trout 1992 Brown Trout 1993 Brown Trout 1994 Chinook Salmon 1995 Brown Trout 1996 Steelhead Trout 1997 Steelhead Trout 1998 Rainbow Trout 1999 Rainbow Trout 2000 Rainbow Trout 2001 Lake Trout *2002 Brook Trout **2003 Steelhead Price Each $2.00 $2.00 $2.00 $2.25 $2.25 $2.25 $2.25 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $9.25 $9.25 TOTAL AMOUNT DUE TOTAL NUMBER OF STAMPS ORDERED (CONTINUED ON BACK) $ Amount

TOTAL AMOUNT DUE TOTAL NUMBER OF STAMPS ORDERED

* signifies Stamp available December, 2001 **signifies Stamp available December, 2002

Quantity

Description 1980 Bobwhite Quail 1981 Ring-necked Pheasant 1982 Ruffed Grouse 1983 Wild Turkey 1984 Bobwhite Quail 1985 Wild Turkey 1986 Ring-necked Pheasant 1987 Bobwhite Quail 1988 Wild Turkey 1989 Ring-necked Pheasant 1990 Bobwhite Quail 1991 Ring-necked Pheasant 1992 Ruffed Grouse

Price Each $1.00 $1.00 $1.00 $1.00 $3.00 $3.00 $3.00 $3.00 $6.75 $6.75 $6.75 $6.75 $6.75

GAME BIRD HABITAT STAMPS Quantity Amount

Description 1993 Wild Turkey 1994 Wild Turkey 1995 Ring-necked Pheasant 1996 Ruffed Grouse 1997 Bobwhite Quail 1998 Ring-necked Pheasant 1999 Wild Turkey 2000 Bobwhite Quail 2001 Ruffed Grouse *2002 Wild Turkey

Price Each $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $6.75 $

Amount

**2003 Ring-necked Pheasant

TOTAL AMOUNT DUE TOTAL NUMBER OF STAMPS ORDERED

Date (month, day, year)

Amount

$

Check

Money Order