Big Game Tag Record Form - 1997
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1THE FOLLOWING RECORD MUST BE COMPLETED AS NECESSARY BEFORE THE SALE OF ANY BIG GAME TAG
Department of Fish & Game
VENDORS ONLY:
BIG GAME TAG RECORD
Licensing Section
Send Part 1 to Fish and Game
P.O. Box 25525
Give Part 2 to Licensee
Juneau, Alaska 99802-5525
Keep Part 3 for Your Files
This certifies that the licensee named below has purchased the big game tag(s) indicated. (PLEASE PRINT)
HARVEST TICKET NUMBERS
Hunting License Number
Class of License
Date of Tag Purchase
Caribou
C-
Name (First, MI, Last)
Deer
D-
Address
Moose
M-
City, State, Zip Code
Country
Sheep
S-
Vendor Location
Vendor I.D. No.
License
Vendor Name
MILITARY AFFIDAVIT
NONRESIDENT AFFIDAVIT
NONRESIDENT ALIEN AFFIDAVIT
Per AS 16.05.340(d)
Per AS 16.05.407(a)
Per AS 16.05.408
You must have a nonresident alien license to purchase
You must have a nonresident hunting license to purchase
NOTE: You must have a nonresident hunting license to
tags. You must complete this affidavit before the purchase
tags. You must complete this affidavit before the purchase of
purchase tags. You must complete this affidavit before the
of any nonresident alien* tag .
any brown/grizzly bear, sheep, or goat tag if you are U.S.
purchase of any military tag .
citizen but not a resident of Alaska.
I am entitled to the special nonresident Military Big Game Tag
at one-half of the nonresident rate for the following reason:
Pursuant to AS 16.05.407, I hereby certify that I will be
Pursuant to AS 16.05.408, I hereby certify that I will be
guided by:
guided by:
1. I am a member of the military service on active
duty permanently stationed in the state; or
of
, Alaska
of
, Alaska
2. I am a dependent of a member of the military
who is
who is
service on active duty permanently stationed in the
state.
A. A Master or Registered Alaskan guide; or
A. A Master guide; or
Branch of Military
B. A resident spouse or relative within and
B. A Registered Guide under AS.08.54.
including the second degree of kindred as
Rank and Serial Number
defined in the Alaska Game and Guiding
*Nonresident alien means a person who is not a citizen
Regulations.
Assigned Duty Station
of the U.S. and whose permanent place of abode is not
Specify Relationship:
in the U.S. (AS 16.05.940(22))
If a Dependent, Specify Relationship
Please CIRCLE the appropriate rate.
RESIDENCY CERTIFICATION
Tag Type
Tag
Resident Nonresident. Military
N.R. Alien
Total Fee
MUST BE SIGNED
Number(s)
Price(1R)
Price(2N) Price(3M)
Price (4A)
ALASKA RESIDENT AS 16.05.940(25):
"resident"
means, • a person (including an alien) who is physically
Br. / Grz. Bear (BG)
$ 250.00
$ 650.00
$ 25.00
$ 500.00
present in Alaska with the intent to remain indefinitely and
$ 112.50
$ 300.00
Black Bear (BL)
$ 225.00
make a home here, has maintained that person's domi-
$ 112.50
$ 300.00
$ 225.00
cile in Alaska for the 12 consecutive months immediately
$ 225.00
$ 650.00
Bison (BF)
$ 450.00
preceding this application for a license, and is not claim-
ing residency or obtaining benefits under a claim of
$ 162.50
$ 425.00
Caribou (CC)
$ 325.00
residency in another state, territory, or country; • a
$ 162.50
$ 425.00
$ 325.00
member of the military service or U.S. Coast Guard who
$ 162.50
$ 425.00
$ 325.00
has been stationed in Alaska for the 12 consecutive
$ 162.50
$ 425.00
$ 325.00
months immediately preceding this application for a
license; or • a dependent of a resident member of the
$
75.00
$ 200.00
Deer (DD)
$ 150.00
military service or U.S. Coast Guard who has lived in
$ 150.00
$ 400.00
Elk (EE)
$ 300.00
Alaska for the 12 consecutive months immediately pre-
Goat (GG)
$ 150.00
$ 400.00
$ 300.00
ceding this application for a license. A person who does
$ 200.00
$ 500.00
Moose (MM)
$ 400.00
not otherwise qualify as a resident may not qualify by
virtue of an interest in an Alaska business.
$ 200.00
$ 500.00
$ 400.00
Pursuant to AS 16.05.940, I hereby certify that I
$500.00
$ 550.00
$ 1,500.00
Muskox Bull (OX)
$ 1,100.00
qualify for Alaska residency status:
$ 25.00
N/A
N/A
MuskoxCow (OX-MU)
N/A
x
Sheep (SS)
$ 212.50
$ 550.00
Signature
$ 425.00
$
15.00
$
50.00
Wolf (WF)
$
30.00
I have personally reviewed the information on this
$
15.00
$
50.00
$
30.00
record and I hereby certify under penalty of perjury
that all information on this record, including any
$
87.50
$ 250.00
Wolverine (WV)
$ 175.00
completed affidavit, is true and correct. I understand
this information is subject to public disclosure.
x
TOTAL TAG FEES COLLECTED .
Signature of Applicant
Date
$
NOTICE: THE LICENSEE'S COPY MUST BE CARRIED ON THE HUNTER'S PERSON WHEN THE HUNTER IS IN THE FIELD.
11-180(11-97)
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