Taxidermist License Application - Wyoming Game And Fish Department
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TAXIDERMIST LICENSE APPLICATION
FOR THE YEAR OF
Application requested:
Renewal (Previous year license #_______________ )
Resident
(LICENSE FEE $67.00)
AND
Original
Nonresident
(LICENSE FEE $702.00)
LAST NAME
FIRST NAME and Middle Initial
DATE OF BIRTH
HOME MAILING ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
SPORTSPERSON I.D.
Weight
Height (Ft - Inches)
Eye Color
Hair Color
Sex
NAME OF BUSINESS
BUSINESS MAILING ADDRESS
CITY
STATE
ZIP CODE
BUSINESS PHONE NUMBER
BUSINESS PHYSICAL LOCATION
CITY
STATE
ZIP CODE
XXX – XX –
SOCIAL SECURITY NUMBER (Last 4 digits Required)
Resident applicant must complete the following:
PROOF OF WYOMING RESIDENCY:
WY Driver’s License Number or WY ID Card Number
YRS WY RES. or Days Active Military in WY
Complete the PROOF OF
ONE of the
RESIDENCY form
OR
following must
ON NEXT PAGE
be provided:
Under penalty of prosecution, I swear or affirm that the information given by me on this application is true and correct. I swear, under penalty of prosecution, that I am a Wyoming Resident as
defined in W.S. 23-1 -102(a)(ix)(xv) and 23-1-107 and have been domiciled in Wyoming for not less than one (1) year and have not claimed residency elsewhere for any purpose during the one (1) year
immediately preceding the date of application for this license(s). See Page 12, Section 13 (p)
I, the undersigned, depose and say that I am a taxidermist and that I have a working knowledge of Wyoming Game and Fish laws pertaining to big
and trophy game animals, small game animals, furbearing animals, game birds, migratory game birds, protected birds and animals and game fish. I
further depose and say I will operate in accordance with regulations governing taxidermists approved by the Wyoming Game and Fish Commission.
I understand that I must keep a daily record of all wildlife specimens received from within or without the State of Wyoming. Said records shall
include names and addresses of persons from whom wildlife specimens were received, date of receipt, location where taken, approximate date killed,
description and any identifying number (i.e., licenses, tags, shipping permits, export permits, etc.) documenting origin.
_____________________________________________
_____________________________
Applicant Signature
Date
OR
_____________________________________________
_____________________________
Parent or Legal Guardian’s Signature
Date
(If Applicant is under the age of 18)
RESIDENT TAXIDERMIST: Submit your application form and fee to your local game warden for approval.
Money Order or Cashier’s Check
NONRESIDENT TAXIDERMIST: Submit your application form and fee (
) to the
Game and Fish Headquarters at the address indicated below.
A Resident Taxidermist shall mail or deliver taxidermist records to the Regional Game and Fish Office in accordance with the address listed on the
back of this form in the geographic region where the taxidermist business is located on or before January 31 of the year following for which the
taxidermist license was valid.
A Nonresident Taxidermist shall mail or deliver taxidermist records to the Wyoming Game and Fish Department, Wildlife Division Law
Enforcement, 5400 Bishop Boulevard, Cheyenne, Wyoming 82006 on or before January 31 of the year following for which the taxidermist license
was valid.
The Department approval block is located on the back of form.
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