Resident Application For Lifetime Hunting And Fishing Licenses
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1
2D
G
I
F
EPARTMENT OF
AME AND
NLAND
ISHERIES
L
L
S
IFETIME
ICENSE
ALES
P.O. B
2978
OX
H
, VA 23228-9700
ENRICO
866-721-6911
(Hearing impaired call TDD# 804-367-1278)
Commonwealth of Virginia
Resident Application for Lifetime Hunting and Fishing Licenses
Instructions and Lifetime License Information on page 2 (Allow up to 45 days for processing)
Is this license a Gift?
No
Yes-If Yes, complete a Certificate of Applicant form to mail in with this application (see instructions).
All fields with an asterisk * are required below:
DGIF Customer ID#: __________________________________
*Are you a United States Citizen?
Yes
No-If No, Provide your Visa or Green Card #:
________________________________
*Applicant’s Name: _______________________________________________________________
*Gender:
Male
Female
(Please Print)
First
Middle Initial
Last Name
*Virginia Driver’s or DMV Identification number last 4 digits: ____________
*Last 4 digits of Social Security No: ______________
*Mailing Address: ________________________________________________________________________________________________
*City: ___________________________________________________State: ________________ Zip: _____________+ _____________
*Physical Address (if different from Mailing): __________________________________________________________________________
*Telephone (Cell, Home, Work, Other):
Date of Birth
__________- ___________-_____________
*
: ________/________/____________
E-mail Address: __________________________________________________________________________________________________
Please check the license(s) you are applying for:
Your Current Age:
**Hunting
Freshwater
Trout
**Saltwater
Trapping Total
$
Resident Junior (age 2 thru 11)
$ 255.00
N/A
N/A
N/A
N/A
$
Resident 44 and Under
$ 260.00
$ 260.00
$ 260.00
$ 276.00
N/A
$
Resident 45 to 50
$ 210.00
$ 210.00
$ 210.00
$ 132.00
N/A
$
Resident 51 to 55
$ 160.00
$ 160.00
$ 160.00
$ 99.00
N/A
$
Resident 56 to 60
$ 110.00
$ 110.00
$ 110.00
$ 66.00
N/A
$
Resident 61 to 64
$ 60.00
$ 60.00
$ 60.00
$ 35.00
N/A
$
Resident 65 and Older
$ 20.00
$ 20.00
$ 20.00
**$
5.00
$ 20.00
$
Upgrade your lifetime license to a New Premium Hard Durable Plastic card w/design:
$ 10.00
$
Contribution to “Hunters for the Hungry”:
$ 2.00
$ 5.00
$ 10.00
$ 20.00
$ 50.00
TOTAL AMOUNT DUE
$
**For additional information on the Hunting and Saltwater lifetime licenses please see page 2.
*Hunting Lifetime License Qualification – Must have at least one to qualify for the hunting lifetime license:
I have a
Hunter Education
Certificate:
Required for persons between the ages of 12 and 16 old and those that had never held
Provide Certificate State and Number: ____________________________________
a hunting license after the age of 18:
I have previously been issued a hunting license
I am under the age of 12 and exempt from Hunter Education
requirements until age 12
Note: The
Apprentice license
does not qualify as a hunting license.
*Proof of Virginia Residency and Age Requirement; submit a readable photocopy of one of the documents listed below:
Valid Virginia driver’s license
Valid DMV ID card
Applicant’s Certification
By signing this application, I certify that the above information is true and correct. Any person who knowingly makes a false
statement in order to secure a license shall be guilty of a Class 2 misdemeanor, punishable by up to six months in jail, a fine of up
to $1,000 or both.
*Signature: ____________________________________________________________ Date: ___________________________________
LTL-RESAGE-0716
Instructions on second page.
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