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APPLICATION FOR WEST VIRGINIA
TROPHY FISH CITATION
Fill out completely. Fill out form and then print, or write legibly on printed form, please.
Name: ___________________________________________ Today’s Date: _________________
Address: _______________________________________________________________________
______________________________________________________________________________
Species: _________________________________________ Date Caught: ___________________
Weight: ___________________________ Length: __________________________ inches
Name of stream or lake:__________________________________________________________
County where caught: ____________________________________________________________
□ Weight Certification (Check if certifying your fish by weight)
Witness Signature: __________________________________________________________
Where fish was weighed: _____________________________________________________
Phone: _______________________________________________
□ Length Certification (Check if certifying your fish by length with a witness)
Witness Signature: ___________________________________________________________
Address of Witness: __________________________________________________________
__________________________________________________________________________
□ Length Certification (Check if certifying your fish by length with a photograph)
Please print your name, address, and species of fish on the back of the photograph.
Photographs become property of the West Virginia DNR and will not be returned.
Signature of Applicant: ___________________________________________________________
Phone: __________________________________________
Ma
il to: West Virginia Division of Natural Resources
324 4
th
Avenue, Room 306
South Charleston, West Virginia 25303
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Completed 1 November 2020

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