Form 624 - Hunt Permit-Tag/license Application Form
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1
2Hunt Permit-Tag/License Application Form
Fourth Choice
First Choice
Second Choice
Third Choice
Fifth Choice
Hunt Number
Hunt Number
Hunt Number
Hunt Number
Hunt Number
Use only standard blue or black ink (no gel ink)
APPLICANT A
APPLICANT B
Date of Birth
Date of Birth
( m
m ) ( d
d ) ( y
y
y
y )
( m
m ) ( d
d ) ( y
y
y
y )
Check One
Check One
Federal Requirement: Social Security Number
Federal Requirement: Social Security Number
Non-resident
Non-resident
Arizona Hunting License Number
Arizona Hunting License Number
(must include the 2 letter prefix)
(must include the 2 letter prefix)
Department I.D. Number if different from SSN
Department I.D. Number if different from SSN
Resident
Resident
Last Name
First
M.I.
Last Name
First
M.I.
Address
Address
City
State
Zip Code
City
State
Zip Code
Daytime Phone Number
Daytime Phone Number
SIGN ON LINE BELOW
SIGN ON LINE BELOW
Signature
X
Signature
X
(Must be signed by or for Applicant A)
_____________________________________________
(Must be signed by or for Applicant B)
_____________________________________________
Sex
Weight
Height
Hair
Eyes
AZ Residency
Sex
Weight
Height
Hair
Eyes
AZ Residency
Complete only to apply
Complete only to apply
Ft. In.
Yrs. Mos.
Ft. In.
Yrs. Mos.
for a Hunt License
for a Hunt License
No license
No license
Class G Hunting
Res
A
Class G Hunting
Non-Res
D
Class G Hunting
Res
A
Class G Hunting
Non-Res
D
refund will be
refund will be
Class F Hunt/Fish
Res
B
Class F Hunt/Fish
Non-Res
E
Class F Hunt/Fish
Res
B
Class F Hunt/Fish
Non-Res
E
issued if you
issued if you
Class F Youth Hunt/Fish
Res
C
Youth Hunt/Fish
Non-Res
F
Class F Youth Hunt/Fish
Res
C
Youth Hunt/Fish
Non-Res
F
are not drawn.
are not drawn.
If unsuccessful, I wish to donate $ ______.____ from my refund to the Big Game Habitat Fund.
If unsuccessful, I wish to donate $ ______.____ from my refund to the Big Game Habitat Fund.
APPLICANT C
APPLICANT D
Date of Birth
Date of Birth
( m
m ) ( d
d ) ( y
y
y
y )
( m
m ) ( d
d ) ( y
y
y
y )
Check One
Check One
Federal Requirement: Social Security Number
Federal Requirement: Social Security Number
Non-resident
Non-resident
Arizona Hunting License Number
Arizona Hunting License Number
(must include the 2 letter prefix)
Department I.D. Number if different from SSN
(must include the 2 letter prefix)
Department I.D. Number if different from SSN
Resident
Resident
Last Name
First
M.I.
Last Name
First
M.I.
Address
Address
City
State
Zip Code
City
State
Zip Code
Daytime Phone Number
Daytime Phone Number
SIGN ON LINE BELOW
SIGN ON LINE BELOW
Signature
X
Signature
X
(Must be signed by or for Applicant C)
_____________________________________________
(Must be signed by or for Applicant D)
____________________________________________
Complete only to apply
Sex
Weight
Height
Hair
Eyes
AZ Residency
Complete only to apply
Sex
Weight
Height
Hair
Eyes
AZ Residency
Ft. In.
Yrs. Mos.
Ft. In.
Yrs. Mos.
for a Hunt License
for a Hunt License
No license
No license
Class G Hunting
Res
A
Class G Hunting
Non-Res
D
Class G Hunting
Res
A
Class G Hunting
Non-Res
D
refund will be
refund will be
Class F Hunt/Fish
Res
B
Class F Hunt/Fish
Non-Res
E
Class F Hunt/Fish
Res
B
Class F Hunt/Fish
Non-Res
E
issued if you
issued if you
Class F Youth Hunt/Fish
Res
C
Youth Hunt/Fish
Non-Res
F
Class F Youth Hunt/Fish
Res
C
Youth Hunt/Fish
Non-Res
F
are not drawn.
are not drawn.
If unsuccessful, I wish to donate $ ______.____ from my refund to the Big Game Habitat Fund.
If unsuccessful, I wish to donate $ ______.____ from my refund to the Big Game Habitat Fund.
FORM 624/390 3/08
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