SPOrT FISHIng regulaTIOnS - Oregon Department of Fish and Wildlife

100
REV. 2/24/2012:Lt
Mail To:
ODFW - License Services
3406 Cherry Avenue NE
Salem, OR 97303-4924
(503) 947-6100
Angling License
Mail Order
Application
Oregon Department of Fish and Wildlife
Issue Date: _______________
Initials: ___________________
ODFW USE ONLY
Charge orders may be faxed to: (503) 947-6117 or 947-6113. We are unable to accept telephone orders.
Certification of resident status is required for Oregon residents. please read and sign in the box below.
� Resident � Non-Resident Driver's License #: State:
���-��-����
LAST NAME FIRST NAME M.I. SOCIAL SECURITY # (required)
MAILING ADDRESS ODFW HUNTER / ANGLER ID
��-��-����
CITY STATE ZIPCODE DATE OF BIRTH (MM-DD-YYY)
� MALE � FEMALE
DAYTIME PHONE # EMAIL
Mark your Angling Licenses and Tags
choices Fees License Types
Annual Licenses:
� $58.00 annual resident Combination angling/hunting
� $164.75 sports pac license (18 years & older)
� $33.00 annual resident angling license
� $106.25 annual non-resident angling license
� $52.00 Juvenile sports pac license (12 to 17 years)
� $9.00 annual resident Juvenile angling license (14 to 17 years)
� $20.25 annual non-resident Juvenile angling license (14 to 17 years)
� FREE annual Youth Under 14 angling license (13 years & younger, both resident & non-resident)
� $26.50 annual adult Combined angling harvest tag (18 years & older)
� $8.50 annual Juvenile Combined angling harvest tag (14 to 17 years)
� $16.50 hatchery harvest tag
� $25.50 annual resident sr. Citizen Combination angling/hunting (70 years & older and 5 years in Oregon)
� $15.00 annual resident sr. Citizen angling (70 years & older and 5 years in Oregon)
� $17.00 two-rod angling license
Daily Licenses: (salmon-steelhead-sturgeon-halibut tags included) Starting Dates for Daily Licenses:
� $16.75 1 – day angler
� $31.50 2 - day angler
� $46.25 3 - day angler
� $58.00 4 - day angler
� $59.75 7 - day angler (non-residents only)
Shellfish Licenses:
� $7.00 annual resident shellfish license
� $20.50 annual non-resident shellfish license
� $11.50 3 - day non-resident shellfish license
Other Charges:
� $ 2.00 shipping and handling
Total Fees: $ Note: To purchase licenses "on line" see our home page @ http://www.dfw.state.or.us
Oregon Residents (read & sign) Seniors Citizens (read & sign) PAYMENT METHOD (DO NOT SEND CASH)
i, the undersigned, hereby certify and declare
that the information i provided to obtain this
license/tag is true and correct. to acquire an
Oregon resident license, i certify that i have
resided continuously within Oregon no less
than 6 months immediately prior to applying
for this license/tag.
Signature (required for Oregon residents)
i, the undersigned, hereby certify and declare
that the information i provided to obtain this
license/tag is true and correct. to acquire a
senior citizen license, i hereby certify that i
have reached the age of 70 and have resided in
Oregon no less than 5 years. i further certify
that i have resided continuously within Oregon
no less than 6 months immediately prior to
applying for this license.
Signature (required for Oregon residents)
� i've enclosed a Check or money Order
payable to ODFW.
� Visa® � master Card®
Credit Card number:
expiration Date:
Signature (required for all credit card purchases)
Text highlighted in blue is new or changed from 2012