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Get NH BUS1314A 2013

__ HOME TELEPHONE Hair__________ Eyes________ Sex _______ I certify that I have a permanent physical disability and as a result of that disability I cannot operate a conventional bow or a compound bow. ________________________________________________ APPLICANT’S SIGNATURE ______________________________________ DATE Permittee subject to penalties for making unsworn false statements under RSA 641:3. Note: Persons holding a permanent disabled crossbow permit shall not use longbow.

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