DEPARTMENT OF GAME AND INLAND FISHERIES LIFETIME …

1 LTL-RESAGE-0719 Instructions on second page. DEPARTMENT OF GAME AND INLAND FISHERIES LIFETIME LICENSE SALES BOX 2978 HENRICO, VA 23228-9700 804-367-1000(Hearing impaired call TDD# 804-367-1278)Commonwealth of Virginia Resident Application for LIFETIME Hunting and Fishing Licenses Instructions and LIFETIME License Information on page 2: (Please allow up to 45 days for processing) All fields with an asterisk * are required: *Are you a United States Citizen? Yes No If No, Provide your Visa/Green Card #: _____ *Applicant s Name: _____ *Gender: Male Female First Middle Initial Last Name *Virginia Driver s or DMV ID last 4 digits: _____*Last 4 digits of Social Security No: _____*Mailing Address: _____*City: _____ State: _____Zip: _____+ _____*Physical Address (if different from mailing): _____*Telephone (Cell, Home, Work, Other): _____- _____-_____ *Date of Birth: _____/_____/_____E-mail Address: _____*Please check the license(s) you are applying for:Your Current Age: *HuntingFreshwater Trout Saltwater Trapping Total Resident Junior (age 2 thru 11) $ 2 N/A N/A N/A N/A $ Resident 44 and Under $ 26.

2 00 $ 26 .00 $ 26 .00 $ N/A $ Resident 45 to 50 $ 21 .00 $ 21 .00 $ 21 .00 $ N/A $ Resident 51 to 55 $ 16 .00 $ 16 .00 $ 16 .00 $ N/A $ Resident 56 to 60 $ 11 .00 $ 11 .00 $ 11 .00 $ N/A $ Resident 61 to 64 $ 6 .00 $ 6 .00 $ 6 .00 $ N/A $ Resident 65 and Older $ 2 .00 $ 2 .00 $ 2 .00 **$ $ 2 .00 $ Upgrade your LIFETIME license to a Premium Hard Durable Plastic card: $ $ Contribution to Hunters for the Hungry : $ $ $ $ $ $ For License information refer to page 2 TOTAL AMOUNT DUE $ *Hunting LIFETIME License Qualification Must have at least one to qualify for the hunting LIFETIME license:I have a Hunter Education Certificate: Required for persons between the ages of 12 and 16 old and all others who have never held a hunting license after the age of 18: Provide Certificate State, Date and Number of course taken: _____ Under the age of 12 and exempt from Hunter Education.

3 I have previously been issued a hunting license. Provide state and year of last hunting license: _____ Note: The Apprentice license does not qualify as a hunting license. Proof of Virginia Residency and Age Requirement; submit a readable photocopy of one of the documents listed below: Valid Virginia driver s license Valid DMV ID card 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-0719 Instructions Page INSTRUCTIONS (Please allow up to 45 days for processing.) Virginia residents 45 years of age and older can go online and purchase LIFETIME licenses; you must have a validVirginia driver s license in order to complete the online process.

4 Please visit .Otherwise you can print, complete and mail this LIFETIME License Application form to us along with requireddocumentation and fee(s). The applicant must qualify and supply proof of Virginia residency to buy a resident license. This license is validfor the LIFETIME of the license holder even if the license holder becomes a nonresident of the Commonwealthsubsequent to the purchase of the license. The Agency will accept proof of residency from one of the following: acopy of a valid Virginia driver s license or a valid Virginia DMV identification card. When purchasing a Junior LIFETIME Hunting License or if the applicant is under 16 years of age proof of residencyis still required: A school ID, DMV issued Identification, DMV issued learners permit, or a copy of their birthcertificate are acceptable for residency verification.

5 All applicants must meet Hunter Education requirements if applying for a LIFETIME hunting license. (Not applicableon the Junior Hunting License see below.) Persons age 12 thru 15 receiving a hunting license must submit a copyof their Hunter Education Certificate with the application. The Junior LIFETIME Hunting License will be valid for hunting when a child is accompanied and directly supervisedby a properly licensed adult. Upon the child s 12th birthday, this license shall become invalid and shall remaininvalid until certification of completion in hunter education is received. To request a new validated card, pleasesubmit the Youth Hunter Education Compliance Form. All LIFETIME licensees are required to obtain all additional state and local licenses, permits and stamps as requiredby law. The LIFETIME hunting represents the basic state small game license.

6 See the hunting and fishing regulationswhich are available where licenses are sold or on our web site at 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 theTREASURER OF VIRGINIA. Return this application with all supporting documents and payment to: DEPARTMENT of Game and INLAND FISHERIES Attention: LIFETIME License Sales Box 2978 Henrico, VA 23228-9700 LIFETIME LICENSE INFORMATION There is an option on the application to upgrade this LIFETIME license request to new premium hard durable plastic cardfor a $ fee. The Hunting LIFETIME license is the state resident hunting license and is valid for small game only.

7 You are stillREQUIRED to obtain any additional licenses or permits in addition to the LIFETIME hunting if you participate in theseactivities: Which may include for the hunting season bear, deer and turkey license, archery license, muzzleloaderlicense, bonus deer permit, state or national forest permit, and migratory stamps. **The Saltwater LIFETIME licenses is sold in cooperation with Virginia Marine Resources Commission (MRC).Residents 65 and older: You are not required to buy a Saltwater Fishing License, but you are required to registerannually with the Fisherman Identification Program (FIP) by visiting have the option of purchasing the above LIFETIME saltwater license for $ to avoid the annual FIP registrationprocess. For further questions on the FIP program please call (757) 247-2200. Visit for purchasing of additional annual licenses if needed.