Form Ltl Resage 0515 – Fill Out and Use This PDF

DEPARTMENT OF GAME AND INLAND FISHERIES

LIFETIME LICENSE SALES

P.O. BOX 90778

HENRICO, VA 23228-0778

866-721-6911

(Hearing impaired call TDD# 804-367-1278)

Commonwealth of Virginia

Resident Application for Lifetime Hunting and Fishing Licenses

Mailing Address: ________________________________________________________________________________________________

City: _____________________________________________________ State: ___________ Zip: _____________ + ___________

Contact Telephone#: ____________________________________________ Date of Birth: _________________________________

E-mail Address: __________________________________________________________________________________________________

Please check the license(s) you are applying for:

*The Hunting lifetime license replaces the state resident hunting license and is valid for small game only. You are still REQUIRED to obtain any additional licenses or permits in addition to the lifetime hunting if you participate in these activities: Which may include for the hunting season – bear, deer and turkey license, archery license, muzzleloader license, bonus deer permit, state or national forest permit, and migratory stamps.

**The Saltwater lifetime licenses sold in cooperation with Virginia Marine Resources Commission (VMRC). Attention Residents 65 and older: You are not required to buy a Saltwater Fishing License, but you are required to register annually with the Fisherman Identification Program (FIP) by calling 1-800-723-2728 or online at www.mrc.virginia.gov/FIP . You have the option of purchasing the above lifetime saltwater license for $5.00 and avoid the annual FIP registration process.

*Hunting Lifetime License Qualification – Must have at least one to qualify for the hunting lifetime license (check or circle below):

Proof of Virginia Residency Required – Include a photocopy of one of the following documents (check or circle below):

Proof of Age Required – Include a photocopy of one of the following documents (check or circle below):

Applicant’s Certification

By signing this application, I certify that the above information is true and correct. Any person who knowingly makes a false statement in order to secure a license shall be guilty of a Class 2 misdemeanor, punishable by up to six months in jail, a fine of up to $1,000 or both.

Signature: ____________________________________________________________ Date: ___________________________________

LTL-RESAGE-0515

Instructions on second page.

INSTRUCTIONS

(Please allow up to 45 days for processing.)

•Print and complete the Lifetime License Application form.

•If purchasing this license as a gift the purchaser must provide the applicant’s information, and mail in along with a completed and signed Certification of Applicant form.

•The Certification of Applicant form can be found by clicking on the hyperlink or visiting http://www.dgif.virginia.gov/licenses/lifetime/gift.pdf .

•The applicant must qualify and supply proof of Virginia residency to buy a resident license. This license is valid for the lifetime of the license holder even if the license holder becomes a nonresident of the Commonwealth subsequent to the purchase of the license. The Agency will accept proof of residency from one of the following: a copy of a valid Virginia driver’s license, a valid Virginia DMV identification card, a Virginia voter registration card or a completed Certification of Applicant form.

•When purchasing a Junior Hunting License or the Legacy Hunting/Fishing License submit a completed Certification of Applicant form.

•All applicants must meet Hunter Education requirements if applying for a lifetime hunting license. (Not applicable on the Junior Hunting License – see below.) Persons age 12 thru 15 receiving a hunting license must submit a copy of their Hunter Education Certificate with the application.

•The Junior Lifetime Hunting License will be valid for hunting when a child is accompanied and directly supervised by a properly licensed adult. Upon the child’s 12th birthday, this license shall become invalid and shall remain invalid until certification of completion in hunter education is received. To request a new validated card, please submit the Youth Hunter Education Compliance Form.

•All lifetime licensees are required to obtain all additional state and local licenses, permits and stamps as required by law. The lifetime hunting represents the basic state small game license. See the hunting and fishing regulations which are available where licenses are sold or on our web site at www.dgif.virginia.gov.

•Select the license(s) you wish to purchase.

•Verify that you submit copies of all required documents.

•Sign and date the application. The application must be signed by the applicant unless it is a gift.

•Include a PERSONAL CHECK, MONEY ORDER or CASHIER’S CHECK made payable to the TREASURER OF VIRGINIA:

Department of Game and Inland Fisheries

Attention: Lifetime License Sales

P.O. Box 90778

Henrico, VA 23228-0778

LTL-RESAGE-0515

Instructions Page