Washington Department Of Fish And Wildlife Application For Special License
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1
2Department Use Only
License Number
Card #
Washington Department of Fish
and Wildlife
License Type
Payment Receipt
Resident
Non-Resident
Application for Special License
Total Fee
For the Year _______
See current fee sheet for license type and fee amount at
Amount Received
Type of License (Check One)
Trapping*
Game Farm
Fur Dealer
Taxidermist
Resident Juvenile
New
Ledger Needed?
Ledger Needed?
#____________________
Trapper Certificate Number
Y
N
Renewal
Y
N
(For First Time Trappers,
copy must be attached)
UBI #
UBI #
UBI #
Last Year
Trapped? ___________
st
th
* Expires April 1
after date of issuance. Return trapper reports by April 10
License Owner(s) ID #
Last Name
First Name
Middle Initial
Business Name (Except Trappers)
Permanent Address
Mailing Address
City
State
Zip Code
Phone Number
Birthday (M/D/Y)
Sex
Hair
Eyes
Weight
Height
Social Security Number (required for trappers)
Make Fees payable to WDFW
I have been a resident of Washington for 90 days
st
License will expire December 31
of Issuance Year
And am not licensed as a resident in any other state
Mail Applications Directly to:
I am not a resident of Washington
Department of Fish and Wildlife
License Division
I hereby certify under penalty of perjury under the laws of the state of
600 Capitol Way N
Washington that the foregoing is true and correct.
Olympia, WA 98501-1091
Office Location:
Signature of License Holder
1111 Washington St. S.E. Olympia WA
Phone Number: (360) 902-2464
TDD: (360) 902-2207
Signed at (Place)
Fax: (360) 902-2945
This is a public document. Please be advised that the information submitted may be shared with other government agencies.
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