Taxidermist License Application - Wyoming Game And Fish Department (Page 2 of 2) in pdf

Casper Regional Office

3030 Energy Lane, Suite 100

1-800-233-8544

Casper, WY 82604

Cody Regional Office

2820 State Highway 120

1-800-654-1178

Cody, WY 82414

Green River Regional Office

351 Astle

1-800-843-8096

Green River, WY 82935

Jackson Regional Office

P.O. Box 67, 420 N. Cache

1-800-423-4113

Jackson, WY 83001

Lander Regional Office

260 Buena Vista

1-800-654-7862

Lander, WY 82520

Laramie Regional Office

528 South Adams

1-800-843-2352

Laramie, WY 82070

Pinedale Regional Office

P.O. Box 850

1-800-452-9107

Pinedale, WY 82941

Sheridan Regional Office

700 Valley View Drive

1-800-331-9834

Sheridan, WY 82801

TO BE COMPLETED BY DEPARTMENT

REVIEWED AND APPROVED BY:

__________________________________

_________________________________________

GAME WARDEN

COMMERCIAL OPERATIONS COORDINATOR

SIGNATURE & DATE

__________________________________

_________________________________________

GAME WARDEN

COMMERCIAL OPERATIONS COORDINATOR

Printed Name

COMMENTS: _____________________________________________________________________________________

NOTE:

Please mail this approved application form and proper fee to the following:

WYOMING GAME AND FISH DEPARTMENT

LICENSE SECTION

5400 BISHOP BOULEVARD

CHEYENNE, WY 82006-0001

PROOF OF WYOMING RESIDENCY

If you do not have a current Wyoming driver’s license or a current Wyoming Identification card, the following information must be provided (Please Print).

FAILURE TO PROVIDE THIS INFORMATION SHALL RESULT IN THE DENIAL OF A LICENSE BEING ISSUED.

PLEASE PROVIDE A VERIFIABLE ANSWER TO ONE OF THE FOLLOWING (Please Print):

I, or the person for whom I am applying (Resident applicant under the age of 18), have/has resided at the following address(es) for the past one (1) year immediately preceding the date of

this application:

___________________________________________________________________/________________________________________________________________________________

Street Address

Mailing Address

Current or last Wyoming School attended: ___________________________________________

Location: _____________________________________________________

I was a resident of Wyoming at the time I entered the military and have continued serving in active military duty; AND I have no claim of residency in any other state for any purpose.

______ YES, I meet the above criteria per W.S. § 23-1-107

I was stationed in Wyoming for ninety (90) days or more, but was NOT a Wyoming resident when I entered the military; AND am currently an active member of the military; AND I

have made no claim of residency in any other state territory or country for any purpose; AND I have maintained my voter registration in Wyoming.

______ YES, I meet the above criteria per W.S. § 23-1-107

If Active Duty Military, I hereby certify under penalty of perjury that the United States __________________________________________ (Branch) has permanently stationed me at

_______________________________________ (Station) Wyoming as of ________________________ (Date) and I am prepared to produce a copy of the Official Orders upon request.

If a minor dependent, name of parent or legal guardian who is a Wyoming Resident: ____________________________________

I further understand that the Wyoming Game and Fish Department will check the information provided to verify applicant’s residency in the state of Wyoming.

Resident Applicant’s Signature

Parent/Guardian Signature (Resident Applicant Under Age of 18)

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