Form 2738-A "Crossbow Permit Application" - Arizona

What Is Form 2738-A?

This is a legal form that was released by the Arizona Game and Fish Department - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2020;
  • The latest edition provided by the Arizona Game and Fish Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 2738-A by clicking the link below or browse more documents and templates provided by the Arizona Game and Fish Department.

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Download Form 2738-A "Crossbow Permit Application" - Arizona

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A
G
F
D
RIZONA
AME AND
ISH
EPARTMENT
CROSSBOW PERMIT APPLICATION
R12-4-216
FOR DEPARTMENT USE
Date Received
Region:
ONLY
Permanent Permit
Approved:
Denied:
Date
Temporary Permit valid for one-year
EXPIRES
from date signed by Healthcare Provider
Date:
Approved By:
FEE: $13 RESIDENT/$15 NONRESIDENT
[PLEASE PRINT OR TYPE]
The Arizona Game and Fish Department may issue a CROSSBOW permit if the applicant has one or more of the following physical
limitations: An amputation involving body extremities required for stable function to use conventional archery equipment; A spinal
cord injury resulting in a disability to the lower extremities, leaving the applicant nonambulatory; A wheelchair restriction; A
neuromuscular condition that prevents the applicant from drawing and holding a bow; A failed manual muscle test involving the
grading of shoulder and elbow flexion and extension or an impaired range-of-motion test involving the shoulder or elbow; A
combination of comparable physical disabilities resulting in the applicant's inability to draw and hold a bow; or A failed functional
draw test that equals 30 pounds of resistance and involves holding it for four seconds. The functional draw test may not be used to
determine eligibility for the permit when it is not associated with a disability.
Department ID Number or SSN:
Date of Birth
Name
Mailing Address
City
State
Phone
Zip
Eyes
Gender
Weight
Height
Hair
Number of Years Resident
Resident
Do you have an
Yes
Non Resident
AZ Champ Permit
No
Physical Address (if different than mailing)
Email
Applicant's Signature
Date
It is unlawful for any person to obtain by fraud or misrepresentation a license to take wildlife. Any license fraudulently obtained is void from the
date of issuance. By signing this document I affirm that I meet the eligibility requirements of this rule and the information provided on the
application is true and accurate.
HEALTH CARE PROVIDER CERTIFICATION
"Health Care Provider means" a person who is licensed to practice by the federal government, any state, or U.S. territory
with one of the following credentials: Medical Doctor, Doctor of Osteopathy, Doctor of Chiropractic, Nurse Practitioner
or Physician Assistant.
I hereby certify that
meets the requirements for a CROSSBOW permit.
Permanent Disability
Temporary Physical Limitation from Date:
Until
Healthcare Provider's Name
Phone
License Number
Name of Medical Facility
Address of Medical Facility
City
State
Zip
Provider's signature
Date
FORM 2738-A Revised 12/20 FOLE
A
G
F
D
RIZONA
AME AND
ISH
EPARTMENT
CROSSBOW PERMIT APPLICATION
R12-4-216
FOR DEPARTMENT USE
Date Received
Region:
ONLY
Permanent Permit
Approved:
Denied:
Date
Temporary Permit valid for one-year
EXPIRES
from date signed by Healthcare Provider
Date:
Approved By:
FEE: $13 RESIDENT/$15 NONRESIDENT
[PLEASE PRINT OR TYPE]
The Arizona Game and Fish Department may issue a CROSSBOW permit if the applicant has one or more of the following physical
limitations: An amputation involving body extremities required for stable function to use conventional archery equipment; A spinal
cord injury resulting in a disability to the lower extremities, leaving the applicant nonambulatory; A wheelchair restriction; A
neuromuscular condition that prevents the applicant from drawing and holding a bow; A failed manual muscle test involving the
grading of shoulder and elbow flexion and extension or an impaired range-of-motion test involving the shoulder or elbow; A
combination of comparable physical disabilities resulting in the applicant's inability to draw and hold a bow; or A failed functional
draw test that equals 30 pounds of resistance and involves holding it for four seconds. The functional draw test may not be used to
determine eligibility for the permit when it is not associated with a disability.
Department ID Number or SSN:
Date of Birth
Name
Mailing Address
City
State
Phone
Zip
Eyes
Gender
Weight
Height
Hair
Number of Years Resident
Resident
Do you have an
Yes
Non Resident
AZ Champ Permit
No
Physical Address (if different than mailing)
Email
Applicant's Signature
Date
It is unlawful for any person to obtain by fraud or misrepresentation a license to take wildlife. Any license fraudulently obtained is void from the
date of issuance. By signing this document I affirm that I meet the eligibility requirements of this rule and the information provided on the
application is true and accurate.
HEALTH CARE PROVIDER CERTIFICATION
"Health Care Provider means" a person who is licensed to practice by the federal government, any state, or U.S. territory
with one of the following credentials: Medical Doctor, Doctor of Osteopathy, Doctor of Chiropractic, Nurse Practitioner
or Physician Assistant.
I hereby certify that
meets the requirements for a CROSSBOW permit.
Permanent Disability
Temporary Physical Limitation from Date:
Until
Healthcare Provider's Name
Phone
License Number
Name of Medical Facility
Address of Medical Facility
City
State
Zip
Provider's signature
Date
FORM 2738-A Revised 12/20 FOLE