This entry is for: STATE RECORD FISH____ BIG FISH____ CATCH AND RELEASE FISH______

(CHECK ONE)

1. Species of fish: ____________________________________________________________

2. Total length: _______________________________inches Girth:________________inches

3. Date caught______________________________________________________________

4. Weight of fish(A or B): A; Spring scale:______ pounds _______ouncres B:Computer(digital) scale:_______pounds

5. Name of water where caught:__________________________________________________

6. County:___________________________________ 7. Pound test of line:_______________

8. Bait/lure used:_____________________________________________________________

9. Color and size of lure:_______________________________________________________

10. Type of tackle: rod_______________________ reel:_____________________________

11. I hereby state that I have caught this fish on a pole and line and that the enclosed information is correct to the best of my ability.

Name(print):_______________________________________________________________

Signature:_________________________________________________________________

Address:__________________________________________________________________

City:_____________________________________________________________________

Telephone number: Area Code(____) ____________________________________________

Witness verification: We, the undersigned, witnessed the weighing and/or measuring of the above fish and hereby certify that the above information is correct:

1. Signature:________________________________________________________________

Address:__________________________________________________________________

City:_______________________________ State:______________ Zip code:_____________

Telephone number: Area Code(____)_____________________________________________

2. Signature:________________________________________________________________

Address:__________________________________________________________________

City:______________________________ State:______________ Zip code:_____________

Telephone number: Area Code(____)____________________________________________

IF THE ABOVE FISH IS A NEW STATE RECORD:

Certified by:_____________________________ Date:______

(IDNR Fishery Biologist)

Mail to: Ill. Dept. of Natural Resources Division of Fisheries 600 N. Grand Ave., West Springfield, IL 62706