Form 01-805 - Request For Duplicate License(S) printable pdf download

CFEC USE ONLY

COMMERCIAL FISHERIES ENTRY COMMISSION

EFF. DATE ________________________________

8800 Glacier Highway, #109, Juneau, Alaska 99801

DATE MAILED _____________________________

(907) 789-6150

DATE DENIED _____________________________

Request for Duplicate License(s)

FEES PAID $ _______________________________

INSTRUCTIONS: This form may be used to request a replacement permit card, vessel license or permit certificate when the original has been lost, stolen or

damaged. If the original license was not received in the mail, a duplicate license may be requested ONLY if at least five working days have elapsed since the

original was issued by the Commission. The Request for Duplicate form CANNOT be used as a temporary license while waiting for the original license to be

received in the mail. When a request for a duplicate permit card or vessel license is approved, the original license becomes VOID and it is then ILLEGAL for it

to be used at any time. Effective September 1, 1994, the appropriate fees for the duplicate licenses requested must be submitted with the Request for

Duplicate form. Checks or money orders should be payable to the State of Alaska.

The carbon copy of the completed form may be used as a temporary permit or vessel license ONLY if the bottom section of the form has been validated by an

employee of the Entry Commission, the Dept. of Fish and Game or Division of Fish and Wildlife Protection. In this case, the original copy of the form should be

mailed to CFEC, the first carbon copy may be kept by the applicant for use as a temporary permit or vessel license and the second copy may be kept by the

agent. The permit number (including the D or Y at the end) must be written by hand on the fish tickets. If the original license(s) were not received in the

mail, an agent may validate the form ONLY after contacting CFEC for approval.

Check boxes to indicate the duplicate licenses needed:

Fees:

Original License Was:

Permit Card No. __________________________________ D

$10

Lost

Stolen

Damaged

No. __________________________________ D

$10

Explain what happened to the original license, if known:

Emergency Transfer Permit Card

No. __________________________________ Y

$10

_______________________________________________

Certificate, Permit No. _______________________________

no fee

_______________________________________________

Vessel ADF&G Number Plate, No. _____________________

_______________________________________________

(triangular metal number plate)

Vessel License Receipt Card, No. ______________________

$10 *

Never Received in the Mail (This box cannot be

checked unless at least five working days have passed since

Vessel License Annual Sticker, No. ____________________

$10 *

the license was mailed from CFEC.) The carbon copy of the

form may be used as a temporary license ONLY if authorized

Vessel License Salmon Area Reg. Tab, (area ____________ )

no fee

by CFEC - the following section must be completed by the

agent indicating the name of the CFEC employee contacted:

* Only one $10 fee is required for a vessel sticker and/or receipt card.

CFEC CONTACTED BY ______________________________________________ ON:

CHECK THIS BOX IF VESSEL OWNERSHIP HAS CHANGED SINCE THE CURRENT

APPROVED

DENIED

LICENSE WAS ISSUED. INDICATE THE DATE OF THE OWNERSHIP CHANGE,

DATE

TIME

CFEC EMPLOYEE

_________________________ , AND PROVIDE NEW OWNER INFORMATION BELOW.

CERTIFICATION OF APPLICANT

I swear under penalty of perjury that all information supplied by me on this form and in all supporting documents is true and complete to the best of my

knowledge. I further certify that I am the:

permit holder

vessel owner

agent for the vessel owner

other (explain)

_____________________________________________

____________________________________

_______________

_____________

Name of Permit Holder or Vessel Owner (printed)

Social Security No.

Date of Birth

ADF&G No.

Permanent Mailing Address: _________________________________________________________________________________________________

Mailing address for duplicate(s) ____________________________________________________________________________________________

(if different) ______________________________________________________________________________________________________________

_____________________________________________________

Signature of Applicant

Subscribed and sworn to before me this ________ day of _________________ , 19 _______ , at ___________________________________________

_____________________________________________________

Notary Public or Alaskan Postmaster

Comm. Expires ________________________________________

THE CARBON COPY OF THIS FORM MAY BE USED AS A TEMPORARY LICENSE FOR UP TO 14 DAYS ONLY IF IT IS SIGNED BELOW BY AN AUTHORIZED AGENT OR EMPLOYEE OF THE ENTRY

COMMISSION, DEPT. OF FISH AND GAME OR DIVISION OF FISH AND WILDLIFE PROTECTION.

__________________________________________________

_______________________________________

__________________________

_________________

____________

SIGNATURE OF AGENT

NAME (PRINTED)

OFFICE & TITLE

DATE SIGNED

VALID UNTIL

01-805 (REV. 3/98)