Application For 100 % Permanent Disability Fishing/combination License printable pdf download

RHODE ISLAND

DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

235 Promenade Street, Providence, RI 02908-5767

TDD 401-222-4462

Office of Boat Registration & Licensing

Floor, Room 360 (401) 222-6647

Application for 100% Permanent Disability Fishing/Combination License

Eligibility Requirements:

Persons with Disability who are 100% Permanently Disabled and are eligible for a Fishing/Combination License, are required to present the

ORIGINAL DOCUMENT OF THE FINAL DECISION(S), on agency letterhead, from the appropriate federal agency(ies) that issued the required

disability decision(s), i.e., the Social Security Administration or the Department of Veteran Affairs for a fishing license. In addition to the above, for a

hunting license the applicant MUST also provide a prior RI or (New for 2016) current or prior OUT OF STATE hunting license, a hunter safety

card from any state, OR AN HONORABLE DISCHARGE (DD-214) and present the ORIGINAL DOCUMENT OF THE FINAL DECISION(S), on

agency letterhead, from the appropriate federal agency (ies) that issued the required disability decision(s), i.e., the Social Security Administration or the

Department of Veteran Affairs. THIS LICENSE, ONCE ISSUED IS PERMANENT.

Persons with Disability who are 100% Totally Disabled and are eligible for a Fishing/Combination License, are required to present the

ORIGINAL DOCUMENT OF THE FINAL DECISION(S), on agency letterhead, from the appropriate federal agency(ies) that issued the required

disability decision(s) i.e., the Social Security Administration or the Department of Veteran Affairs for a fishing license. Instead of the above

documentation, DEM will accept a current disability beach pass (disability picture ID) from the Parks & Recreation Division/DEM. For a hunting license,

the applicant MUST also provide a prior R hunting license or (New for 2016) a current or prior OUT OF STATE hunting license, a hunter safety

card from any state, OR AN HONORABLE DISCHARGE (DD-214) and present the ORIGINAL DOCUMENT OF THE FINAL DECISION(S), on

agency letterhead, from the appropriate federal agency(ies) that issued the required disability decision(s), i.e., the Social Security Administration or the

Department of Veteran Affairs. THIS LICENSE, ONCE ISSUED IS FOR A ONE YEAR PERIOD EXPIRING YEARLY THE LAST DAY OF FEBRUARY.

In future years, persons with disabilities must provide the division with the original document of the final decision(s), on agency letterhead, from the

appropriate federal agency(ies) that issued the required disability decision(s), i.e., the Social Security Administration or the Department of Veteran Affairs

that indicates the continuing nature of the permanent disability.

Veterans:

In order to be determined to be eligible for a 100% Permanent Disability Fishing/Combination License, applicants are required to present

the ORIGINAL DOCUMENT OF THE FINAL DECISION(S), from the Department of Veteran Affairs for a fishing license. For a hunting license, the

applicant MUST also provide a prior RI hunting license or (New for 2016) a current or prior OUT OF STATE hunting license, a HUNTER SAFETY

CARD from any state, OR AN HONORABLE DISCHARGE (DD-214). THIS LICENSE, ONCE ISSUED IS PERMANENT.

Name

Address:

: ______________________________________________________

_________________________________________________

City:

State:

Zip Code:

Date of Birth:

Sex: M/F

_________________________________

__________

____________

Driver's License # _____________________ Issuing State: _____Hair Color: _____ Weight: _____ Eye Color: _____ Height:_____

*If additional information is needed please provide us with one of the following:

Phone number:__________________________ or Email address:______________________________

PLEASE CHECK ONE: (NO FEE REQUIRED FOR THE FISHING AND COMBINATION DISABILITY LICENSES)

PDFF (

) FISHING DISABILITY

PDCM (

) COMBINATION DISABILITY

**NOTE: A Prior RI hunting license or (New for 2016) a current or prior out of state hunting license, hunter safety card from any state, or a

DD-214.

NEED TO SUBMIT A COPY OF A CURRENT RHODE ISLAND HUNTING LICENSE FOR ALL PERMITS & STAMPS:

PERMITS & STAMPS (Fee Required)

_____ Waterfowl Conservation Stamp $7.50

_____ Pheasant permit $15.50

______Hip Permit (no fee) Harvest Info Program

_____ Turkey Permit

____Resident $7.50 _____Non-Resident $20.00

Applicant’s Signature______________________________________________________________Date________________

Please read next page or reverse side prior to signing

ALL LICENSES REQUIRE A COPY OF A PHOTO ID (IF MAILING)

PHOTO IDENTIFICATION (IF IN PERSON)

APPLICANTS WILL BE REVIEWED ON A CASE BY CASE BASIS

Notes: Checks/Money Orders payable to State of RI – DEM & mail or deliver to the address below

Mail to: RI DEM, 235 Promenade St., Room 360, Providence, RI 02908

Application For 100 % Permanent Disability Fishing/combination License

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