HUNTING/FURTAKER
LICENSE APPLICATION
Resident
License
Price
Stamp #
Back Tag #
Non-Res License
Price Stamp
# Back Tag #
___Res
Adult Hunt $20.00 ________ _________ ___Non Res Hunt $101.00 _______ _______
___Res Adult Furtaker $20.00________ _________ ___Non Res Furtaker $ 81.00_____ _________
___Jr
Hunting (12-16) $
6.00 ________ _________ ___Non Res Jr
Hunt $ 41.00________ ______
___Jr Furtaker (12-16) $ 6.00________ _________ ___Non Res Jr Fur $ 41.00 _______ ______
___Jr
Combo
$ 9.00 _______ _________
___Non Res Jr Combo$
51.00 ______ ______
___Res
Sr Hunt (65+)
$13.00 _______ _________
___Res Sr Furtaker $13.00________ _________
___Resident Archery $16.00 ________ ___Non Res Archery $ 26.00 _______
___Resident Muzzleldr $11.00 _______ ___Non Res Muzzleldr $ 21.00 _______
___Res Migratory Bird $ 3.00 ________ ___Non Res Migratory Bird $6.00 _____
___Resident Bear $16.00________ ___Non Resident Bear $ 36.00__________
___DAV
Hunting
FREE ________ _______
___Non Res 7 Day
Small Game
___DAV Furtaker FREE ________ ________ Valid From: ___________ To: ____________
DAV Claim #
NAME:
__________________________________________________________
MAIL
TO:
ADDRESS: _______________________________________________________ Catherine Benedict
CITY,
STATE & ZIP:
_________________________ ______________________ Susq. Co. Treasurer
TELEPHONE
NO.
___________________Corrective Lens: Y N
PO Box 218
Valid
Drivers License # & State
__________________*Required
Soc Sec # ___________
Montrose, PA 18801
Date
of Birth: ___________Sex:
_____ Height: ________Eye Color: ________ (570) 278-4600
Signature
of Applicant (X)____________________________________________
Ext. 130, 131 & 132
(Signature of applicant PLUS parent or guardian for persons under age 17)
All mail orders must add $1.50 for postage. For resident licenses you must include positive proof of PA residency, i.e. copy of PA drivers license. For Nonresidents - Please send a certified check or money order in US currency.