Form 010 - Nonresident General Combination License Application 2001
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12001 MONTANA
010
NONRESIDENT GENERAL COMBINATION
File No.
Date Received
LICENSE APPLICATION
(Dept. use only)
(Dept. use only)
Photocopies Acceptable
RETURN APPLICATION TO: FISH, WILDLIFE & PARKS
SPECIAL LICENSING
406-444-2950
1420 E 6 AVE
PO BOX 8012
HELENA, MT 59604-8012
This application is for those who want to apply for a General Nonresident Combination license for 2001. YOU CAN-
NOT APPLY FOR OR PURCHASE MORE THAN ONE LICENSE OR SUBMIT MORE THAN ONE APPLICATION.
ALL OF THE FOLLOWING LICENSES ARE SOLD THROUGH A COMPUTER DRAWING AND APPLICA-
TIONS MUST BE POSTMARKED ON OR BEFORE MARCH 15. APPLICATIONS ARE CONSIDERED FINAL
& CANNOT BE CHANGED OR WITHDRAWN. THIS APPLICATION IS VALID ONLY FOR 2001 GENERAL
LICENSES.
**PREFERENCE: DO YOU WISH TO PARTICIPATE IN THE BONUS POINT SYSTEM FOR ONE OF THE
FOLLOWING LICENSES? ($20 Fee — Please refer to insert for details on this program.)
YES
NO
Big Game Combination License: $478.
1.*
If you applied for a General Big Game Combination License in 2000, were you successful in obtaining one? Yes
No
Did Not Apply
Elk Combination License: $428
2.
If you applied for a General Elk Combination License in 2000, were you successful in obtaining one?
Yes
No
Did Not Apply
3.*
Deer Combination License: $248
*If you are unsuccessful in drawing this license, are you interested in receiving information on additional deer-only licenses
that may become available after May 15? Yes
No
PARTIES: Check box if you’re applying as a party. Enclose up to 5 applications in ONE envelope. APPLICATIONS IN ERROR WILL BE REMOVED
FROM THE PARTY & THE REMAINING ONES PROCESSED AS A PARTY. (See insert for details on party applications.)
List party members:
(First & Last Name) 1. _______________ 2. _______________
No. in party
Dept. use only
3. _______________ 4. _______________ 5. _______________
M
NAME: FIRST
MI
LAST
JR, SR, ETC.
DATE
MM
DD
YYYY
Dept. use only
OF
BIRTH
MAILING ADDRESS:
SEX:
WEIGHT:
HEIGHT:
A
CITY:
STATE:
ZIP CODE:
EYES:
HAIR:
N
EMPLOYER:
PHONE:
HOME
WORK
COUNTRY:
D
(
)
(
)
A
SOCIAL SECURITY NUMBER (REQUIRED)
CHECK
DRIVER’S LICENSE
PHOTO ID
MILITARY
ONE
STATE:
NUMBER:
I
T
D
* A nonresident 12 through 17 years of age must submit, with all hunting license
O
applications, a certificate (or copy of the certificate) verifying he / she has completed
a course in the safe handling of firearms from any state or province.
R
Bowhunters: See #10 on insert.
ORIGINAL SIGNATURE OF APPLICANT — WRITE — DO NOT PRINT
All statements on this form are true and correct. I understand that if I subscribe to any
(MUST BE APPLICANT’S SIGNATURE—NO ONE ELSE MAY SIGN FOR APPLICANT)
Y
false statements in this application that I am subject to criminal prosecution.
(Faxed or photocopied signature not acceptable)
Your license or refund (if unsuccessful) will be mailed to the address listed above by the end of April.
DID YOU REMEMBER??
NO PERSONAL OR COMPANY CHECKS ACCEPTED
To fill in all “Mandatory” information?
Paid By: Money Order, Cashier’s Check, or International Draft on
US Bank
To send Cashier’s Check or Money Order for proper amount?
(Send cash at your own risk)
Check #
________________________________________
If you checked “yes” for preference, enclose an additional $20
NEED INFORMATION FAST:
or Montana Hotline 1-900-225-5397
Total $ Amount of This Application
______________________
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