Fillable Arizona Game and Fish Department (602) 942-3000 www.azgfd.gov (City of Oakland)

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Arizona Game and Fish Department (602) 942-3000 www.azgfd.gov (City of Oakland)

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Arizona Game and Fish Department
5000 W. Carefree Highway • Phoenix, AZ 85086
(602) 942-3000 • www.azgfd.gov
LIFETIME LICENSE APPLICATION
AGE 0–13
AGE 14–29 AGE 30–44
AGE 45–61
AGE 62+
$629 $666 $592 $555 $296
$629 $666 $592 $555
$296
$969 $1,029
$912
$855
$456
$1,500
Resident Lifetime
General Fishing License
Resident Lifetime
General Hunting License
Resident Lifetime
Combo General Hunt/Fish/Trout
Lifetime Wildlife Benefactor
Combo General Hunt/Fish/Trout
Customer ID / Sportsman ID
Residency Years Purchase Is:
— —
For self
As a gift**
Last Name
First Name
Middle Initial
Address
City and State
Zip Code
Phone Number
Sex
Weight
Height
Hair
Age
Date of Birth
( )
Employer/School:
I hereby affirm that the person for whom this license is being purchased has been a resident of/domiciled in the State of Arizona for at least six months
immediately preceding the date of this application and does not claim residency for any purpose in another state or jurisdiction.; OR is a member of the armed
forces of the United States on active duty and stationed in: (a) This state for a period of thirty days immediately preceding the date of applying for a license,
permit, tag or stamp; (b)
Another state or country but who lists this state as their home of record at the time of applying for a license, permit, tag or stamp.
AND that the date of birth and age of that person as provided on this application are true and correct. I understand that pursuant to ARS 17-341, it is
unlawful for a person to obtain a license to take wildlife by fraud or misrepresentation, and that a license so obtained is void and of no effect from the
date of the issuance. I understand I must provide acceptable proof of domiciled to the Department upon request.
An original or certified copy of the applicant’s birth certificate, driver’s license, Motor Vehicle Division identification card or U.S. passport must accompany each
application. These items will be returned to the applicant. Photocopies are subject to verification.
I understand that this license is non-tra
nsferrable and non-refundable.
Signature of Applicant Printed Name of Applicant Date
If this license is to be mailed to any address other than the one
shown above, complete the information below:
Name:
Address:
City, State:
Zip:
AGFD USE ONLY
Date Issued:
Amount Paid:
Effective Date:
CSR Initial:
Continued on Reverse . . . .
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An applicant may be required to present acceptable proof of domicile to the Department upon request. See Arizona Revised Statute 17-101.A17 for
the definition of an Arizona resident for the purpose of obtaining a license or permit to take wildlife and R412-4-124 for Proof of Domicile. Verify
Residency Status by checking all appropriate boxes:
I AM NOT CLAIMING RESIDENT PRIVILEGES IN ANY STATE OTHER THAN ARIZONA (EXAMPLES INCLUDE, BUT ARE NOT LIMITED TO:
BEING REGISTERED TO VOTE/VOTING, PAYING RESIDENT STATE INCOME TAX, RECEIVING A RESIDENT PROPERTY TAX CREDIT,
OBTAINING RESIDENT LICENSES TO TAKE WILDLIFE).
I am a driver, have a valid Arizona driver license and am proving a certified copy of my Arizona driver license.
I do not have a valid driver license in a State other than Arizona.
I am a non-driver providing a certified copy of the birth certificate, a notarized copy of Arizona Identification, or other proof of residency
as provided in R12-4-124.
I am a full time student attending school out of state of Arizona and not claiming any resident privileges in that state such as resident
tuition.
I am a full time student attending school in Arizona and have been domiciled in Arizona for a period of not less than six (6) months
immediately preceding the date of this application, paying resident tuition and not claiming any resident privileges in any state other
than Arizona.
I am a fully enlisted member of the United States Armed Forces (i.e. NOT a member of the Reserves or Civilian DOD employee), whose
home of record is Arizona.
I am a fully enlisted member of the United States Armed Forces (i.e. NOT a member of the Reserves or Civilian DOD employee) who is
currently stationed in Arizona on military orders for at least 30 days preceding this application (Provide a certified copy of orders).
________ (Initial) ALL LIFETIME LICENSE APPLICATIONS ARE SUBJECT TO REVIEW BY LAW ENFORCEMENT PRIOR TO ISSUANCE. IF YOU HAVE
QUESTIONS REGARDING YOUR RESIDENCY STATUS CONTACT A DEPARTMENT LAW ENFORCEMENT OFFICER PRIOR TO APPLYING. ONCE AN
APPLICATION IS RECEIVED BY THE DEPARTMENT LICENSE FEES WILL NOT BE REFUNDED IF YOUR APPLICATION IS DENIED FOR ANY REASON.
ANY LICENSE ISSUED BY FRAUD OR MISREPRESENTATION IS VOID AND OF NO EFFECT FROM THE MOMENT OF ISSUANCE. ANY TAGS OBTAINED
PURSUANT TO AN INVALID LICENSE ARE NOT VALID TO TAKE WILDLIFE. IT IS UNLAWFUL TO TAKE WILDLIFE WITHOUT A VALID TAG OR LICENSE.
** If this application is submitted as a gift application on behalf of another person: I understand a license is only valid for use by the license
recipient. It is unlawful to use the personal identifying information of another person with the intent to obtain or use the other person’s identity
for any unlawful purpose. I certify I have the permission of the license recipient to use their personal identifying information for this purpose or
legal authority to do so.
_____________________________________________ ___________________________________
Applicants Relationship to License Recipient Applicant Telephone Number
______________________________________________ ___________________________________
Applicant Signature Date
Lost Lifetime Licenses may be replaced for $8. Please return this application with your remittance to the address shown above.
Below this line reserved for Agency Use:
Approved Denied
_______
__________________ _________________________ ____________________________
Officer Name/Signature Date Law Incident Number (If Applicable)
BFLP_SAM 2.5_FORM
2042_08/04/2021
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Arizona Game and Fish Department (602) 942-3000 www.azgfd.gov (City of Oakland)

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Completed 21 January 2022

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