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APPLICATION FOR BASIC CREEK RESERVOIR ACCESS PERMIT Name: Address: City Resident (with current proof): Yes ☐ No ☐ Driver’s License ID Number (if applicable): DOB: Adult, Albany City resident ($10.00) ☐ Adult, non-resident ($20.00): ☐ Child under 16 years (No charge) ☐ (Children must be accompanied by an adult permit holder). Telephone Number: Day Night In case of emergency, contact: NYS Fishing License: Yes ☐ No ☐ If yes, please provide ID number: Did you possess a Basic Creek Reservoir permit previously: Yes ☐ No ☐ Main interest in recreating at the Basic Creek Reservoir: Fishing ☐ Hiking ☐ Bird Watching ☐ Other: PLEASE REVIEW THE BASIC CREEK RESERVOIR RULES AND REGULATIONS. ONCE YOU HAVE REVIEWED THE REGULATIONS, PLEASE BRING THE COMPLETED APPLICATION TO THE CITY OF ALBANY DEPARTMENT OF WATER AT THE ABOVE ADDRESS TO PURCHASE YOUR PHOTO ID PERMIT. PAYMENT OF CREDIT CARD OR CHECK ONLY, CASH WILL NOT BE ACCEPTED. Name: Signature: Date: KATHY SHEEHAN CITY OF ALBANY DEPARTMENT OF WATER & WATER SUPPLY 10 NORTH ENTERPRISE DRIVE ALBANY, NEW YORK 12204 TELEPHONE (518) 434-5300 FAX (518) 434-5332 JOSEPH E. COFFEY, JR., P.E. MAYOR COMMISSIONER ---PAGE BREAK---