Form 08-4010 - Master Guide License Application (Page 2 of 2) in pdf

Form 08-4010 - Master Guide License Application Page 2

YES

Are you a resident of the State of Alaska? (definition of resident on instruction page) ...........

Will you personally pilot an aircraft to transport clients? ...........................................................

(If yes, please submit a copy of your commercial pilot’s license or complete the attached “Affidavit of Flying

Experience.”)

Will you contract to guide or outfit big game hunts or provide transportation services during the licensing

period?

Yes, I will be contracting to guide or outfit big game hunts or provide transportation services during

the licensing period. I certify that I will possess and maintain, during the licensing period, assets,

general liability insurance, or a bond totaling at least a minimum of $100,000 that will be available for

payment of a judgment against me resulting from my big game hunting service. (AS 08.54.680 and

12 AAC 75.220)

No. If this should change during the licensing period, I certify that I will notify the department within

ten days of any change to the above (12 AAC 75.220(d)).

Applicant Signature

WARNING: The department may deny issuance, suspend, or revoke the license of a person who has

obtained or attempted to obtain a license to practice as a Master Guide by fraud or deceit. The person may

also be subject to criminal charges for perjury or unsworn falsification (AS 11.56.210 and AS 11.56.230).

I certify that the statements on this application are true and correct.

Sign Here

Signature of Applicant

Date

SUBSCRIBED AND SWORN to before me this ______ day of

Notary Public for the State of

SEAL

My Commission Expires:

(or postmaster stamp if notary is not available)

08-4010 (Rev. 10/00)

Form 08-4010 - Master Guide License Application Page 2