Application for 2010 Pennsylvania Fishing License
  1. Print this page
  2. Complete all requested information & sign
  3. Include check or money order payable to:
    Susquehanna County Treasurer
  4. Send to address at right
Susquehanna County Treasurer

 POBox 218

Montrose, Pa 18801-0218
Date                                                  CID# (If none SS#)Required Official Use Only:
License No. Issued
Name Social Security No.
Address Telephone No. (inc. area code)
City State Zip Driver's License No.
Sex (M/F) Date of Birth Height Eye Color
I certify under penalty of law that the statements made herein are true and correct Signature of Applicant
License/Permit Price Line Total
Resident 1 $ 22.70  
Senior Resident 1 [age 65 and over] $ 11.70  
Resident Lifetime 1 [age 65 and over] $ 51.70  
1-Day Resident 1 2 3 $ 11.70  
Non-resident $ 52.70  
7-Day Tourist 2 $ 34.70  
3-Day Tourist 2 $ 26.70  
1-Day Tourist 2 3 [includes all stamps] $ 26.70  
Replacement 4 $ 6.70  
Trout/Salmon Permit $ 9.70  
Lake Erie Permit $ 9.70  
Combination Trout-Salmon/Lake Erie Permit $ 15.70  
TOTAL - Include check or money order payable to: Susquehanna County Treasurer                          
1 Applications for any resident licenses MUST include a photocopy of a valid Pennsylvania driver's license.
2 For 1-Day Resident; 1, 3 and 7-Day Tourist choose start date
-- 3 and 7 day licenses are consecutive days, 1 day licenses are not valid March 15-April 30
 		 Start Date
3 For 1-Day licenses choose start time
-- license is valid for 24 consecutive hours		 Start Time
4 Replacement applications MUST include the CID# of the original license. Price includes any stamps originally purchased.