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Department of Fish and Game, Licensing Section

SPORT FISHING, HUNTING, TRAPPING

P.O. Box 25525

Juneau, Alaska 99802-5525

LICENSE APPLICATION

Phone: (907) 465-2376; Fax: (907) 465-2440

e-mail: leah_lakip@fishgame.state.ak.us

IMPORTANT: If you are applying for a license through the mail, please allow 2 to 4 weeks for delivery.

Indicate the type of license(s) you wish to purchase by circling the appropriate price(s) below:

Applicant's Alaska Residency Status

Applicants name (First, Middle Initial, Last)

License Year

(Check one)

(Please read definition of resident below.)

Resident—preceding 12 or more consecutive

Mailing Address

Daytime Phone

Fax Number

months of residency

Years

Months

City, State, Zip Code

U.S. Citizen

Nonresident—Less than 12 consecutive

months of residency

YES

Physical Location of Residence (If same as mailing address, write "same.")

Birthday

Nonresident Alien—1) a person who has not

lived in the State of Alaska for the previous 12

(MM, DD, YYYY)

months, or 2) is not a citizen of the U.S. and

Social Security Number

Weight (lbs) Eye color Hair color

Height

Sex

whose permanent place of abode is not in the U.S. (AS

Ft. In.

16.05.940 (22 & 26E).

Note: If you are a nonresident applying by mail, indicate the

Your e-mail address:

date you will be leaving for Alaska: _________

Social Security Number Advisory: If you are a United States resident

Payment Information

(Make checks payable to State of Alaska)

and over 16, you are required to provide your social security number when

applying for a sport license. You will be denied a license if you do not give

Check or Money Order

Visa

MasterCard Expire

your social security number.

This information is used by the Child Support Enforcement Division, Dept.

Card No.

of Public Safety, and Dept. of Labor (Fisherman's Fund).

Signature _________________________________________________

ALASKA RESIDENT AS 16.05.940(26): "resident" means, • a person

(including an alien) who is physically present in Alaska with the intent to

PERSONS EXEMPT FROM LICENSE REQUIREMENTS

remain indefinitely and make a home here, has maintained that person's

domicile in Alaska for the 12 consecutive months immediately preceding

• Residents or nonresidents under the age of 16 years for sport fishing.

this application for a license, and is not claiming residency or obtaining

• Residents under the age of 16 years for hunting and trapping.

benefits under a claim of residency in another state, territory, or country;

• Residents 60 years of age or more who have been residents for one year

• a member of the military service or U.S. Coast Guard who has been

or more. (Note: A Permanent ID Card, which must be in possession while

stationed in Alaska for the 12 consecutive months immediately preced-

sport fishing, hunting, or trapping, is available without charge from the

ing this application for a license; or • a dependent of a resident member

Department of Fish and Game.)

of the military service or U.S. Coast Guard who has lived in Alaska for

Waterfowl Conservation Stamp $5.00 (Not available until July 1.) This

the 12 consecutive months immediately preceding this application for a

stamp is required for anyone who hunts waterfowl except for residents

license. A person who does not otherwise qualify as a resident may not

under the age of 16, and persons who have these license types: Class 5A

qualify by virtue of an interest in an Alaska business.

$5.00, Permanent Identification Card, or Disabled Veteran's License.

RESIDENT

Harvest Information Program (HIP) If you hunt

DUP*

migratory birds, you must first register in the HIP

program by either calling 1-800-WETLAND (1-800-

CLASS

938-5263) or through a license vendor who sells

EIGHTEEN

TWO

THREE A

ONE

THREE B

FOUR

FIVE

waterfowl stamps.

HUNTING

HUNT/TRAP

DUPLICATE

HUNTING

SPORT

$5.00

King Salmon Stamp:

This

HUNTING

TRAPPING

FISHING

stamp is required for anyone

$25.00

$39.00

$15.00

$39.00

$53.00

$15.00

MILITARY*

who fishes for anadromous king

salmon except for residents and

CLASS ONE A

*Note: License classes marked with an asterisk (*)

CLASS 5A*

CLASS

nonresidents (NR) under the age

cannot be issued until the appropriate affidavit has

FISH/ BLIND*

TWELVE

THIRTEEN

FOURTEEN

of 16, and persons who have

been completed. Class One A and Two A Blind

$5.00

$.25

these license types: Class 1A—

requires form 11-524 Affidavit of Blindness; persons

FISHING

CLASS 5B*

CLASS TWO A

$.25, Class 5A—$5.00, Perma-

who wish to purchase a Class 5A, Military, or

SM. GAME

DUP for Class

SPORT

SM. GAME

HUNT/BLIND*

nent ID Card, or Disabled

Duplicate License, must complete affidavit on the

5A Only

FISHING

HUNTING

Veteran's License.

$25.00

back of the license or form 11-521.

$2.00

$15.00

$25.00

$39.00

Resident......$10

ALIEN

NONRESIDENT

Duplicate..... .......... $5

NR Military... ...... $20

CLASS

NR 1-day.... ....... $10;

SIX A

SIX D

SIX B

SIX C

SEVEN

EIGHT

EIGHT A

TEN

FIFTEEN

NINE

NINE C

3-day .................. $20;

14 DAY

7 DAY

3 DAY

1 DAY

HUNTING

6D & 8

7-day.... .............. $30;

SPORT

SM GAME

HUNTING

BIG GAME

SPORT

COMBINA-

14-day......... ....... $50

FISHING

HUNTING

TRAPPING

HUNTING

FISHING

TION

or Annual.... .... $100.

$50.00

$30.00

$20.00

$10.00

$100.00

$85.00

$20.00

$250.00

$300.00

$185.00

$115.00

For each stamp indicate:

For Class 6A, B, C and D STARTING DATE

STARTING HOUR

Begin: Date______Hour____AM PM

I have personally reviewed the information on this application and I certify under penalty of perjury that to the best of my knowledge and belief the

information on this application is true and correct, and that I understand this information is subject to public disclosure except for SSN. My right to

obtain or exercise the privileges granted by the sport fishing, hunting, or trapping license is not suspended or revoked in another state. (NOTE:

Making a false statement, or omitting a material fact, is subject to a maximum penality of $5,000 or 1 year imprisonment, or both, per AS 11.56.210

and AS 16.05.420.)

SIGNATURE

DATE

11-527(7/99)

Form 11-527 - Sport Fishing, Hunting, Trapping License Application- Department Of Fish And Game, Licensing Section

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