Form 08-4008d - Affidavit - Hunting Experience & Residency

Form 08-4008d - Affidavit - Hunting Experience & Residency - 2000

State of Alaska

Department of Community and Economic Development

Division of Occupational Licensing

P.O. Box 110806, Juneau, AK 99811-0806

Telephone: (907) 465-2543 Fax: (907) 465-2974

E-mail: license@dced.state.ak.us

HUNTING EXPERIENCE & RESIDENCY

AFFIDAVIT

This form is to be completed by someone else on your behalf only if you are applying under Option B. You may photocopy

this form if necessary.

I verify that

has the

(Applicant's Name)

following hunting experience in unit

1. Years of Hunting - must list actual calendar year which you can confirm applicant hunted in the unit:

2. Does the applicant physically reside in the unit?

Yes

I certify that the information contained in this affidavit is true and correct, and I have freely completed, without duress,

said affidavit.

I understand that, in accordance with Alaska Statute 11.56.210, any person knowingly or intentionally furnishing false

or fraudulent information when completing this affidavit is subject to imprisonment for not more than one year, a fine of

not more than $5,000.00 or both.

Printed Name

Signature

Date

NOTARIZED

Signed before me this

day of

Notary Public for the State of

SEAL

My Commission Expires:

WITNESSED

WITNESS 1:

(Print Name)

(Signature)

(Date)

WITNESS 2:

(Print Name)

(Signature)

(Date)

08-4008d (Rev. 10/00)

Form 08-4008d - Affidavit - Hunting Experience & Residency - 2000