Application For Fish Resource Permit Form - Alaska Department Of Fish And Game (Page 2 of 4) in pdf

Application For Fish Resource Permit Form - Alaska Department Of Fish And Game Page 2

The purpose of the activities for which a permit is being requested is: ______________

)

(be specific

_____________________________________________________________________

NOTE:

A copy of your STUDY PLAN or RESEARCH PROPOSAL must be

submitted with, and attached to, this permit application

Final disposition of the specimens* collected will be ____________________________

* (specimens may not be sold, traded, bartered, or used in any commercial manner)

The following persons will participate in the field collections under terms of the permit

being requested:

________________________________

_________________________________

________________________________

__________________________________

________________________________

__________________________________

________________________________

__________________________________

________________________________

__________________________________

I certify that all statements entered on this application are true, that I will abide by

all conditions and restrictions of a permit if issued, and promise to submit a

report of activities carried out under terms of such permit within 30 days of its

expiration date.

______________

_____________________________________

(most recent Fish

(signature)

Resource Permit

number, if any)

_____________________________________

(date)

(If applicant is representing a corporation or institution, a certification of affiliation may

be required which must be notarized and attached to this application).

Completed application must be submitted to: Alaska Department of Fish and Game,

P.O. Box 25526, Juneau, AK 99802-5526; ATTN: Division of Sport Fish - Permits (for

permits for all freshwater collections and near short areas), or Division of Commercial

Fisheries - Permits (for permits for marine water collections and for permits involving

propagation).

Form 11-001A (8/99)

page 2 of 2

Application For Fish Resource Permit Form - Alaska Department Of Fish And Game Page 2