Vermont Fish & Wildlife Department Sporting License Application
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1Vermont Fish & Wildlife Department sporting License application
1 Last Name
First Name
m.i.
Date oF Birth
/
/
(Town if different
maiLiNg aDDress
City
state
Zip
resiDeNCe
from mailing)
(area CoDe) teLephoNe NumBer
sex
Weight
height
eye CoLor
(
)
M
F
lbs
ft
in
2
status oF LegaL resiDeNCe
3 harVest iNFormatioN program
WaterfoWl and Woodcock Hunters! You Must
please initial: ________ I have resided in Vermont for the six months
register for tHe Harvest inforMation PrograM
immediately prior to the date of making this license application, and
(HiP).
have not during that period claimed a residence in any other state for
any purpose.
Call Toll Free 1-877-306-7091 (Monday - Friday, 7:45 am to 4:30
pm EST) or visit \HIP.cfm to register
please initial: ________ (N)on-resident I certify that I am not a
resident of the state of Vermont.
and obtain your HIP number.
LiCeNse eLigiBiLity: Valid previous license, a hunter training
Write your HIP # here:_____________________________
certificate, or an affidavit of eligibility must be presented for any
Waterfowl hunters 16 and older must have a valid Federal
hunting, archery or trapping license.
Migratory Bird Hunting Stamp and a valid Vermont Migratory
4 CirCLe LiCeNse types requesteD
Waterfowl Stamp.
1-day, 3-day, 7-day Fishing licenses – fill in dates in Section 4A.
Type
ResidenT
non-ResidenT
5a DiD you huNt BLaCK Bear iN 2013? yes No
Fishing
25.00
50.00
5B DiD you huNt Deer iN 2013? yes No
5-YEAR Fishing
119.00
244.00
Youth Fishing
8.00
15.00
6 permaNeNt LiCeNses For VermoNt
*1 DAY Fishing
n/A
20.00
resiDeNts 65 or oLDer
*3 DAY Fishing
10.00
22.00
Circle the type(s) of license you are applying for:
*7 DAY Fishing
n/A
30.00
1-FishiNg
2-ComBiNatioN (muzzleloader & turkey)
CombinAtion
40.00
135.00
3-arChery
4-trappiNg
5-YEAR CombinAtion
194.00
669.00
2, 3 and 4 require proof of previous license, hunter safety card
Youth CombinAtion
12.00
30.00
or affidavit.
hunting
25.00
100.00
Include a one-time $50.00 fee and mail application to:
5-YEAR hunting
119.00
494.00
Vermont Fish & Wildlife Dept.,1 National Life Dr., Dewey Bldg.
Youth hunting
8.00
25.00
Montpelier, VT 05620-3208
smAll gAmE
n/A
50.00
tRApping
20.00
300.00
7 CertiFiCatioN By sigNature
5-YEAR tRApping
94.00
1,494.00
I hereby affirm under penalty of perjury, that I am eligible to
Youth tRApping
10.00
300.00
purchase this license, that the information on this form is true to
the best of my knowledge, that no Vermont hunting, fishing, or
ARChERY onlY
n/A
75.00
trapping license of mine is currently under revocation, nor my
ARChERY
23.00
38.00
right to obtain one under revocation, that I am not delinquent in
tuRkEY
23.00
38.00
any obligation to pay child support or that I am in good standing
with respect to any unpaid judgment issued by the judicial bureau
muzzlEloADER
23.00
40.00
or district court for fines and penalties for a violation or criminal
EARlY sEAson bEAR
5.00
15.00
offence.
WAtERFoWl stAmp
7.50
7.50
non-Game ConTRibuTion
$
$
sigNature oF appLiCaNt
non-Refundable
$
$
ToTal fees
4a term LiCeNses DATES INCLUSIVE AND CONSECUTIVE
sigNature oF pareNt/guarDiaN For appLiCaNt
* VALID FROM__________________ TO __________________
15 years oLD or youNger
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