Application For Lifetime Sportsman'S License - Georgia Department Of Natural Resources
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1
2Application for Lifetime
SEND PHOTOCOPIES
Sportsman’s License
NO FORMS WILL BE
RETURNED
PLEASE TYPE OR PRINT LEGIBLY
LBRU–Lifetime, 2065 US Hwy. 278, SE, Social Circle, GA 30025
Mail application & attachments to:
nd
*Please see the reverse side (or 2
page) for instructions and detailed documentation requirements.
Official USPS postmark date on mailed envelope is used for age eligibility – request local post office mark.
LAST
FIRST
MI
DRIVER’S LICENSE # (See Document Req.)*
DL STATE
___ ___ ___ ___ ___ ___ ___ ___ ___
MAILING ADDRESS
CITY
STATE
ZIP
___ ___ ___ ___ ___
CITY
STATE
ZIP
PHYSICAL ADDRESS
Same as Mailing Address
___ ___ ___ ___ ___
SSN
DATE OF BIRTH
GENDER
PROOF OF RESIDENCY PROVIDED (See Document Req.)*
GA Driver’s License
Male
Female
State of GA ID Card
___ ___ ___- ___ ___ - ___ ___ ___ ___
M___ ___ D ___ ___Y ___ ___ ___ ___
EMAIL ADDRESS (Optional, will be used to send a pdf of the issued license)
PHONE
TEXT NUMBER (optional)
(
)
(
)
___ ___ ___
___ ___ ___ - ___ ___ ___ ____
___ ___ ___
___ ___ ___ - ___ ___ ___ ___
HUNTER EDUCATION # (Requirements listed on back for each license type)*
HUNTER ED STATE
COUNTY OF RESIDENCE
Lifetime Licenses restricted to: 1. residents of GA; 2. Nonresidents under 2 years of age; 3. Nonresident grandchildren from 2 years to
less than 16 years of age of current RESIDENT Paid Lifetime License holders (does not include free Senior Lifetime License holders).
SELECT LIFETIME LICENSE DESIRED (*Supporting Document Requirements Listed on Back)
Req’d Fee
MARK ONE
License Type
Cost**
** Cost shown includes state license fee plus a $3 transaction fee
[ ]
Infant (Under 2 Years of Age, Resident or Nonresident)
$503
[ ]
Youth (2 thru 15 years, Resident)
$603
[ ]
Adult (16 thru 49 years, Resident)
$753
[ ]
Adult (50 thru 59 years, Resident)
$378
[ ]
Senior Discount (60+, Resident)
$318
[ ]
Veterans (Honorably Discharged, Resident)
$603
[ ]
Military (Active Duty, Resident)
$603
Senior 65+ Sportsman’s (Born On or After July 1, 1952, Resident)
[ ]
$73
[ ]
Senior 65+ Fishing Only (Born On or After July 1, 1952, Resident)
$38
[ ]
Senior 65+ Hunting Only (Born On or After July 1, 1952, Resident)
$38
[ ]
Nonresident Grandchild (2 Years to Less Than 16 Years Old)
$1,503
One plastic lifetime card is included with your purchase of any of the licenses above.
Extra / Replacement Plastic Lifetime Card(s) (Fee = Qty X $13)
Qty ___
$13 ea
Grand Total (add the Req’d fee + any extra cards)
$________
If this application is for a Nonresident Youth Grandchild (2 years to <16 years of age) complete the following:
Name of Grandparent with Paid Lifetime License: _____________________________________________
Lifetime License Number: ________________DOB: ___/____/______ Tel. No: (____)______/__________
O.C.G.A 16-10-20; “A person who knowingly and willfully makes a false, fictitious or fraudulent statement…in any manner within the jurisdiction of any
department or agency of state government…shall, upon conviction thereof, be punished by a fine of not more than $1000 or by imprisonment for not less
than five years, or both.” Applicant Hunter Education Attestation: * If I was born on or after January 1, 1961, I attest that I will obtain hunter education
before using this license for hunting. If for infant or youth, I will make them aware that any person less than 16 years of age must hunt under adult
supervision, except for those 12 to 15 years of age may obtain hunter education to hunt without adult supervision.
______________________
_________________________________________________________________
Date
Signature of Applicant / Parent / Grandparent
Check # ______________________; or
If paying by Credit card, enter card # here:______________________________________
Type of card: Visa MasterCard Discover Expiration Date:____/____/_______ Security Code #______
Billing Address Zip Code (if different from Mailing Address Zip Code Above) ___________________
Credit Card Signature: __________________________________________
DNR Use: Cash
Allow up to 5 days for processing.
Licenses will only be mailed to the Applicants mailing address (No Exceptions). A copy of
this application can be used to hunt or fish, provided you attach a copy of the check/money order used as payment, unless paid by
credit card, and you meet the age requirement for the license for which you have applied.
Rev 7-10-17
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