Form Pwd 341 - Application For Replacement License

Texas Parks and Wildlife Department

4200 Smith School Road, Austin, TX 78744

(800) 792-1112

APPLICATION FOR REPLACEMENT LICENSE

Last Name: _______________________________

First Name: _______________________________

Driver’s License: State ______ No.: _________________________ Date of Birth: ______/______/________

Address: ________________________________________________________________________________

City: ______________________________________

State: __________

Zip: _____________________

Telephone: (_________) ______________________

I certify that I purchased the item(s) checked below.

The item has been lost/destroyed and I request a replacement be issued.

l *111 Resident Super Combo

l *169 Youth Hunting License

$10

$6

l *117 Resident Senior Super Combo

l 231, *232, *233 Resident Fishing Packages

$10

$10

l *503, *504, *505 Res. Comb. Hunt/Fish Pkgs.

l 234, *235, *236 Senior Resident Fishing Packages

$10

$10

l *506, *507, *508 Res. Comb. Senior Hunt/Fish Pkgs. $10

l 250, *251, *252 Non-Resident Fishing Packages

$10

l *101 Resident Hunting License

l *502 Disabled Veteran Super Combo

$10

FREE

l *102 Senior Resident Hunting License

l *990, *991, *992 Lifetime License Tags

$6

$10

l *105 General Non-Resident Hunting License

l *237 Resident Year-from-Purchase All Water Pkg.

$10

$10

l *118 Non-Resident Spring Turkey Hunting License

l *510, *511, *512 Resident Active Military Licenses

$10

FREE

*

I certify the following status of tags at the time my original license above was lost/destroyed.

l Used

l Not Used

1

Rio Grande Turkey valid only in county with bag limit of 4 turkeys

l Used

l Not Used

2

Rio Grande Turkey valid only in county with bag limit of 4 turkeys

l Used

l Not Used

3

Eastern OR Rio Grande Turkey in any county with bag limit of 1 OR Rio in county with bag limit of 4

l Used

l Not Used

4

Rio Grande Turkey in county with bag limit of 1 turkey OR 4 turkeys – NOT VALID IN EAST TEXAS

l Used

l Not Used

5

White-tailed Deer – Antlerless Only

l Used

l Not Used

6

White-tailed Deer – Antlerless Only

l Used

l Not Used

7

White-tailed Deer – Buck OR Antlerless

l Used

l Not Used

8

White-tailed Deer – Buck OR Antlerless

l Used

l Not Used

9

White-tailed Deer – Buck OR Antlerless

l Used

l Not Used

10

Mule Deer – Antlerless Only

l Used

l Not Used

11

Mule Deer – Buck OR Antlerless

l Used

l Not Used

Red Drum Tag

l 157 Non-Resident 5-day Special Hunting License

l 167 Upland Game Bird Endorsement

$10

$3

l 107 Non-Resident Special Hunting (Small Game)

l 168 Migratory Game Bird Endorsement

$10

$3

l 173 Annual Public Hunting Permit

l 135 Archery Hunting Endorsement

$10

$3

l 175 Limited Public Use Permit

l 211 Saltwater Fishing Endorsement

$10

$3

l 106 Resident Trapper

l 256 Freshwater Fishing Endorsement

$3

$3

l 208 Lake Texoma Fishing

$10

l Other: Item Type: ___________ Item Name: ___________________________________________________________________

I understand that under Texas Penal Code §37.10, it is a felony to make a false statement on this form.

Signature of Applicant: ______________________________________

Date: _________________________

License Agent #: _________________ By: _____________________

Send this form to License Section, TPWD

The Texas Parks and Wildlife Department maintains the information collected through this form. With few exceptions, you are entitled to be informed about the information we collect. Under Sections 552.021

and 552.023 of the Texas Government Code, you are also entitled to receive and review the information. Under Section 559.004, you are also entitled to have this information corrected.

PWD 341 – A0900 (6/15)