Application For Sport Fishing, Hunting And Trapping License Form For Alaska Senior Residents printable pdf download

APPLICATION FOR SPORT FISHING, HUNTING AND TRAPPING LICENSE

FOR ALASKA SENIOR RESIDENTS

Alaska residents who are 60 years of age or older and meet the Department of Fish and Game’s residency definition on

the back of this form are eligible for an Alaska Senior Resident License in order to hunt, sport fish, and trap for free. Also,

you are not required to purchase a King Salmon Stamp or a Alaska State Waterfowl Stamp.

Applicants must be physically present in the State of Alaska to apply. Applicants who complete the form and meet age and

residency requirements will be issued an Alaska Senior Resident License within 2 - 6 weeks.

If at any time an Alaska Senior Resident License holder is no longer a resident of Alaska (see definition on back), their

card is immediately void. If your contact information changes, you must notify Fish & Game Licensing within 30 days.

Instructions: Fill out this form completely and mail to: Department of Fish and Game Licensing Section

P.O. Box 115525 Juneau, Alaska 99811-5525, email to adfg.license@alaska.gov or fax to (907)465-2440.

The following situations disqualify applicants from receiving the Senior Resident License; there may be others:

•

Being registered to vote in another state.

•

Receiving benefits under a claim of residency in another state, territory, or country.

•

Having an interest in an Alaskan business does not qualify you as a resident.

PLEASE PRINT CLEARLY - ALL FIELDS MUST BE COMPLETED

Name (First, Middle Initial, Last)

Date of Birth

Sex

Alaska Residency Length

M F

Years

Months

Mailing Address

Physical Address

City, State, Zip Code

Driver's License Number or State ID Number

Daytime Telephone Number

Email Address

--The following 5 questions MUST be answered--

YES

1. Do you meet Dept. Of Fish and Game residency requirements? (See definition on back of form)

YES

2. Did you receive the most recent Alaska Permanent Fund Dividend?

YES

3. Do you claim a homestead or home-owner’s property tax exemption in another state?

YES

4. Did you receive a "resident" hunting or fishing license in another state within the past 12 months?

YES

5. I understand I must surrender my senior resident license if I no longer qualify as an Alaska resident.

The number printed on your senior resident license should be used in lieu of a sport fishing, hunting and trapping license number

in all instances where a license number is required (e.g. draw applications, resident big game tags, harvest tickets, etc.).

I have personally reviewed this application and hereby certify that all of the information provided is true and correct and that I

understand this information may be subject to public disclosure. My right to obtain or exercise the privilege granted by a sport

fishing, hunting, or trapping license is not suspended or revoked in another state. (NOTE: Making a false statement, or omitting a

material fact, is subject to a maximum penalty of $10,000 or one year imprisonment, or both, per AS 11.56.210 and AS 16.05.420.)

Signature of Applicant _____________________________________________

Date _________________________

Please check the correct box:

First Time Applicant

Replacement Card# _________________________

FOR DEPARTMENT HEADQUARTERS USE ONLY

I.D. Number:___________________ Date Issued:______________ Issued By:____________________________

11-523B(09/15)

Application For Sport Fishing, Hunting And Trapping License Form For Alaska Senior Residents

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