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APPLICATION FOR FREE FISHING LICENSE FOR THE BLIND
NAME: __________________________________________________________________
STREET
ADDRESS: _______________________________________________________________
CITY: _____________________________ PHONE NUMBER: ( _____ ) _____- _______
ZIP CODE: _______ - ______ EMAIL: _____________________________________
SOCIAL SECURITY #: ______-_____-______DATE OF BIRTH: _____ / ____ /_____
HAIR COLOR: ______________ EYE COLOR: ___________________
HEIGHT: FEET: _____ INCHES: _____ WEIGHT: _______
HAVE YOU LIVED IN NEW JERSEY FOR SIX MONTHS PRIOR TO THIS
APPLICATION? ____________
ARE YOU A CITIZEN OF THE UNITED STATES? ________
DOCUMENTATION OF IMPAIRMENT FROM THE NJ COMMISSION FOR THE BLIND &
VISUALLY IMPAIRED MUST BE SUBMITTED WITH THIS APPLICATION.
APPLICATION AND DOCUMENTION MUST BE SENT BY MAIL (DO NOT EMAIL OR
FAX PERSONAL INFORMATION). MAIL TO THE FOLLOWING ADDRESS:
NJ DIVISION OF FISH AND WILDLIFE
MC: 501-03, ATTN: FISHING LICENSES
PO BOX 420
TRENTON, NJ 08625-0420
ANY PERSON WHO OBTAINS A LICENSE BY GIVING FALSE INFORMATION IS SUBJECT
TO PENALTY UNDER LAW.
