Form 11-528 - License Application - Fur Dealer Taxidermy Game Farm

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Department of Fish and Game
FUR DEALER
Licensing Section
TAXIDERMY
Box 25525
Juneau, Alaska 99802-5525
GAME FARM
LICENSE APPLICATION
CLASS 41
CLASS 42
CLASS 43
CLASS 45
CLASS 46
CLASS 44
Res. Fur Dealer
Res. Taxidermy
Game Mammal
Game Bird
Nonres. Fur Dealer
Nonres. Taxidermy
Biennial
Biennial
Biennial
or Reptile
Biennial
Biennial
Biennial
$150.00
$500.00
$200.00
$250.00
$50.00
$500.00
BIENNIAL LICENSES are valid for two calendar years. The expiration date of each license is December 31 one year following the year of issuance.
Applicants name (First, Middle Initial, Last)
License Years
Applicant's Alaska Residency Status (Check one)
(Please read definition of resident below.)
Resident—preceding 12 or more
Mailling Address
Daytime Telephone
consecutive months of residency
Years
Months
City, State, Zip Code
U.S. Citizen (circle)
Nonresident—Less than 12 consecutive
months of residency
YES
NO
Nonresident Alien—Does not have a
Physical Location of Residence (If same as mailing address, write "same.")
Birthday
permanent place of abode for one year
(Month,Day,Year)
in the state of Alaska and is not a U.S.
citizen.
Social Security Number
Weight (lbs)
Eye color
Hair color
Height
Sex
Ft. In.
NOTE: If you are applying for a license through the mail please allow 2-4 weeks for delivery
I certify that of the information is true and correct and that I understand this information is subject to public disclosure. (Note: Providing false
information is subject to a maximum penalty of up to a $5000 fine or 1 year imprisonment, or both, per AS 16.04.420 and AS 16.05.420).
Signature of Applicant
Date
Definition of Game Farming (AS 16.05.940(15)) "game farming" means the business of propagating, breeding, raising, or
producing game in captivity for the purpose of marketing the game or their products, and "captivity" means having the
game under positive control, as in a pen or an area of land or water that is completely enclosed by a generally escape-
proof barrier.
Definition of Fur Dealing (AS 16.05.940(17)) "fur dealing" means engaging in the business of buying, selling, or trading in
animal skins, but does not include the sale of animal skins by a trapper or hunter who has legally taken the animal, or the
purchase of animal skins by a person, other than a fur dealer, for the person's own use.
Definition of Taxidermy (AS 16.05.940(34)) "taxidermy" means tanning, mounting, processing, or other treatment or
preparation of fish or game, or any part of fish or game, as a trophy, for monetary gain, including the receiving of the fish or
game or parts of fish or game for such purposes.
Definition of Resident (AS 16.05. 940(26)) "resident" means, • a person (including an alien) who is physically present in
Alaska with the intent to remain indefinitely and make a home here, has maintained that person's domicile in Alaska for the
12 consecutive months immediately preceding this application for a license, and is not claiming residency or obtaining
benefits under a claim of residency in another state, territory, or country; • a member of the military service or U.S. Coast
Guard who has been stationed in Alaska for the 12 consecutive months immediately preceding this application for a
license; or • a dependent of a resident member of the military service or U.S. Coast Guard who has lived in Alaska for the
12 consecutive months immediately preceding this application for a license. A person who does not otherwise qualify as a
resident may not qualify by virtue of an interest in an Alaska business.
11-528 (Rev. 1/00)

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