1 TENNESSEE WILDLIFE RESOURCES AGENCY licensing division . miscellaneous LICENSES APPLICATION. Name _____ Date of Birth _____/_____/_____. Business Name _____ Social Security # _____-____-_____. Address _____ TWRA ID# _____. City _____ State _____ ZIP _____ Phone _____. E-mail _____. PLEASE PRINT NEATLY INSIDE THE BOXES BELOW. Drivers license # (age 16 or older) Gender Hair Eyes Male Female Brown Gray Blue Black Black Bald Brown Gray State of Issue Weight Height . Blonde Auburn Hazel Green Red White CHECK THE APPROPRIATE BOX BELOW. 100 Annual Resident Senior Citizen Commercial Fishing license (expires 2/28)..(No charge). 141 Taxidermist Permit (expires 2/28)..$122. 168 Resident Annual Hunting & Fishing Disabled Under 18 (expires 2/28).. $5. 169 Resident Hunting & Fishing Intellect (One-time fee) $10. 189 Resident Hunting & Fishing - Wheelchair Restricted Citizens license (TN residents only).
2 (One-time fee) $10. 190 Sport Fishing Slat Basket Tag: Enter your Combo Hunting & Fishing license number or Sportsman license $10. 197 Resident Fishing license For The (One-time fee) $10. 198 Resident Disabled Veteran Hunting & Fishing (One-time fee) $10. 199 Resident SSI Disability Fishing (One-time fee) $10. 450 Resident Guide $150. Replacement Resident Guide $8. I (print name)_____ certify that any other copies of this license have been lost/stolen or destroyed and are no longer in use. (initial) _____. 455 Non-resident Guide $650. Replacement Non-resident Guide $8. I (print name)_____ certify that any other copies of this license have been lost/stolen or destroyed and are no longer in use. (initial) _____. Mail application, with check or money order to TENNESSEE WILDLIFE RESOURCES AGENCY Box 41729. Nashville, TN 37204-1729. If paying by credit card, you 1-615-532-0476.
3 FAX your application to 615-837-4262 or EMAIL it to PLEASE DO NOT SEND CASH! _____ Date: _____ Amount Enclosed: $_____. Applicant's Signature Mail signed application along with check, money order, or phone number for credit card payments to the above address. Please provide a good telephone number by which we may contact you for payment information. WR-0142 (Rev. 12/17) DO NOT SEND CASH. Special Requirements by Type Check which one of the following proofs of blindness is submit- ted with this application by a certificate from: ( ) Department of Human Services Type 100 - Free Annual Resident Senior Citizen Commercial ( ) Ophthalmologists Fishing license ( ) Optometrist This type is issued at no charge to those residents 70 years old or older who furnish proof of residency and age. This license expires every year on Type 198 - Resident Disabled Veteran Hunting & Fishing license the last day of February.
4 Holders of this license must apply yearly. Required certification of recent date from the Veterans Adminis- tration must accompany this application. Type 168 - Resident Annual Hunting & Fishing Disabled Under 18 Per TCA 70-2-104 (a) (3a & b), the Director of the TWRA shall accept, Available to TENNESSEE residents under the age of 18 who meet the as evidence of war-connected disability, the following three pieces of requirements of TCA 70-2-104 as amended. The certification of the total information from the Veterans Administration: and permanent disability issued by a physician licensed to practice in 1. Percent of disability (30 percent disabled by reason of war service TENNESSEE must accompany this application. Renewable annually with or 100 percent service connected). current fee. Permits where required. 2. Dates of service 3. Name of war or conflict Type 169 - Resident Hunting & Fishing Intellect Disabled These three pieces of information must be supplied by the Veterans TENNESSEE residents over the age of 10 years may purchase by provid- Administration as separate documents or in the form of a certificate or ing a certification by a physician licensed to practice in TENNESSEE as hav- DD214 form.
5 Ing an intellectual disability as described in TCA 33-1-101. Applicant will By signing my signature on this application, I hereby agree be required to complete the Hunter Education Course as provided in TCA to surrender the license issued to me by reason of this disability 70-2-108. Additional restrictions are listed on the back of the license card. should I become ineligible under the above provisions. Type 189 - Resident Hunting & Fishing Wheelchair Restricted Type 199 - Resident SSI Disability Fishing license Citizens license (TN Residents Only) Residents of TENNESSEE who receive Social Security benefits due to In accordance with TCA 70-2-140 (b), I hereby make application for intellectual disability are entitled to the privilege of sport fishing, per TCA. a Sport Hunting & Fishing Wheelchair Restricted Citizens license and 70-2-104. The TWRA, upon receiving proof of such intellectual disability, agree to surrender this license issued to me should I become ineligible shall issue applicant a permanent Sport Fishing license for a $ fee.
6 Under the provisions below: Applicant must secure written certification from the Social Security Application for a Sport Hunting & Fishing Wheelchair Restricted Citi- Administration that he/she receives SSI benefits due to intellectual dis- zens license is only for TENNESSEE residents restricted to a wheelchair ability. The certification must accompany this application. permanently. All other permits and/or supplemental licenses such as, but not Type 450 - Resident Guide license &. limited to, Tellico Trout, Gatlinburg Trout and Reelfoot Preservation Type 455 - Non-resident Guide license Permits are required in addition to this license . A guide is any individual who accepts compensation for providing A certificate from a physician licensed to practice in TENNESSEE assistance to another in any act of hunting, fishing and/or trapping and must accompany this application stating applicant is permanently shall be required to possess a guide license in addition to any other restricted to a wheelchair.
7 Required license . Entities employing individuals as guides may purchase such resident and non-resident guide licenses as may be necessary for Type 190 - Sport Fishing Slat Basket Tag its employees. Name of reservoir or stream where you plan to fish: _____ Resident Licenses Sport fishing basket tags will only be issued to individuals under age A Social Security Number is required to purchase a 16, over age 65, and those holding a valid annual license . The tag is valid TENNESSEE hunting or fishing license . from March 1 until the last day of February. Only one tag will be issued Resident licenses can be purchased by: per individual. The tag must be securely fastened to the basket. Persons who possess a valid TENNESSEE driver's license or TENNESSEE Slat baskets may have only one outside funnel opening and may be state ID issued by the Department of Safety.
8 TENNESSEE state law made of wood, plastic, or cane slats or splits which are placed lengthwise requires drivers to obtain a TENNESSEE drivers license within 30 days and so constructed that there must be a minimum of four openings in the of residency. Out-of-state drivers license only accepted, for Military catching area, each being at least 1-1/2 inches wide and 6 inches long. Personnel and Student meeting the criteria below. Waters open: All public streams and reservoirs. Persons who do not drive or do not possess a valid driver's license Fish which may be taken: Non-game fish. from another state, but who have lived in TENNESSEE for 90 consecu- Creel Limit: Same as sport fishing. tive days with the genuine intent of making TENNESSEE their perma- nent home, may prove residency by presenting to a TWRA license Type 197 - Resident Fishing license for the Blind agent any two of the following documents.
9 TCA 70-2-104 (a) (1) provides for the issuance of a sport fishing current TENNESSEE voter registration card license for a fee of $ to those residents of TENNESSEE who are current TENNESSEE vehicle registration or title certified as being blind, having a visual acuity with maximum correc- Form I-94 issued by the US Citizenship & Immigration Service tion, not exceeding 20/200 but accompanied by a limitation in the field current rental/mortgage contract or receipt including deed of sale of vision such that the widest diameter of the visual field subtends an for property or receipt for payment of TENNESSEE real estate taxes angle no greater than twenty (20) degrees. The Executive Director of the within last year. TWRA shall accept, as evidence, a certified form from the Department Military personnel on active duty in this state and their children of Human Services or from a physician licensed to practice medicine under the age of 16, who reside with them, regardless of TENNESSEE in this state and who is engaged in the treatment of the human eye, resident status.
10 Or a licensed registered optometrist certifying such persons meet the Students who are enrolled in a TENNESSEE school, college or univer- requirements of this section with reference to the degree of blindness. sity for at least six months, with student ID.