Pgc-L-524 - Resident Senior Lifetime License Application
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1
2Commonwealth of Pennsylvania
PGC-L-524 (Rev. 1/06)
RESIDENT SENIOR LIFETIME LICENSE APPLICATION
(Applicants must be 65 years of age or older, or be 65 by June 30 of current license year.)
Mail orders for resident hunting licenses must include positive proof of residency in the Commonwealth of Pennsylvania and
proof of age. (Submit legible copy of your valid PA Driver's License.) Questions? Contact the License Division at (717) 787-2084.
You may apply on-line at
Hunting Back Tag No. ______________________
License fees are not refundable.
Furtaker Back Tag No. ______________________
Check type of license(s) desired.
Resident Senior Lifetime Hunting
$ 51____________
Archery (Annual)
$ 16 ____________
Resident Senior Lifetime Furtaker
$ 51____________
Muzzleloader (Annual)
$ 11 ____________
Resident Senior Lifetime Combination
$101____________
Bear*** (Annual)
$ 16 ____________
Upgrade to Combination*
$ 51____________
***See current digest for purchase deadline
Migratory Game Bird**
$ 3 ____________
*For current Lifetime License holders only
All mail orders must add $2.50 for postage. (Do not send stamps.)
**Annual-no mail orders
Res. Sr. Furtaker (Annual)
$ 13 ____________
VISA Card No.
Exp. Date
MasterCard No.
Exp. Date
Discover Card No.
Exp. Date
0.00
TOTAL DUE ___________________
American Express No.
Exp. Date
Name
(First)
(Middle Initial)
(Last)
Legal Residence
(Street or R.R.)
(Include Box # if Applicable)
PENNSYLVANIA
State
City
ZIP Code
Social Security No.
Phone No. (
)
Age
Date of Birth
Sex:
Male
Female
Height
Eye Color
Corrective Lens Required?
Yes
No
To apply for a senior lifetime hunting or combination license, I present the following as evidence that I have completed the required
Hunter-Trapper Education course or certify that I have lawfully held a hunting license in a prior year.
Hunter-Trapper Education Training Certificate ___________________________________________
(Date)
A lawfully held hunting license from a prior year _________________________________________
(State)
(Year)
(License No.)
I am unable to produce a prior hunting license but certify below that I held a lawfully obtained hunting license issued by
__________________________ in a prior year.
(State or Nation)
To apply for a senior lifetime furtaker license, I present the following as evidence that I have (1) completed the required Hunter-
Trapper Education course, or certify that I have (2) lawfully held a furtaker or trapping license in a prior year (3) completed a
voluntary trapping course sponsored by the Commission or (4) hunted or trapped furbearers within the last five years.
Hunter-Trapper Education Training Certificate ___________________________
(Date)
A lawfully held furtaker or trapping license from a prior year ______________________________________________
(State)
(Year)
(License No.)
I am unable to produce a prior furtaker or trapping license but certify below that I held a lawfully obtained furtaker or trapping
license issued by ___________________________ in a prior year.
(State or Nation)
I certify that I completed a voluntary trapping course sponsored by the Commission ____________________
(Date)
I certify that I hunted or trapped furbearers within the last five years _________________________________
(If so, mark "Yes" above)
I certify that the above information is correct, all documents presented are true and correct and that my hunting and trapping privileges
are not revoked for this license year.
(Signature of Applicant)
(Date)
Agents Not Responsible for Licenses Lost by Mailing.
Pennsylvania Game Commission
License Division
2001 Elmerton Avenue
Harrisburg, PA 17110-9797
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