Form 05-15A "Commercial Fisheries Entry Commission Request for Duplicate Licenses" - Alaska

What Is Form 05-15A?

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

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Alaska Department of Fish and Game;
  • 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 fillable version of Form 05-15A by clicking the link below or browse more documents and templates provided by the Alaska Department of Fish and Game.

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Download Form 05-15A "Commercial Fisheries Entry Commission Request for Duplicate Licenses" - Alaska

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PO Box 110302
Commercial Fisheries Entry Commission
Juneau, AK 99811-0302
Phone: 907-789-6150
Request for Duplicate Licenses
Toll-Free: 1-855-789-6150
Fax: 907-789-6170
www.cfec.state.ak.us
Please use this form to request a replacement permit card, vessel triangle metal plate, vessel license receipt or a vessel license sticker if the
original issued license for the current calendar year has been lost, not received in the mail, stolen or damaged. This form must be signed,
notarized and mailed/faxed to the Commercial Fisheries Entry Commission (CFEC) with the appropriate fees. Please submit payment by
check, money order or use the attached credit card authorization. All sections of this form must be complete to avoid delays in processing.
Applicant Information:
Applicant’s Name: __________________________________________
CFEC ID#: _________________
Date of Birth ___________
Permanent Mailing Address: ______________________________________________________________________________________
City: _______________________ State: ______ Zip: ___________ Phone Number: _____________________ Check if Unlisted
_____
Temporary Mailing Address (for these licenses): ______________________________________________________________________
City: _______________________ State: ______ Zip: ___________
License Information:
When the duplicate is approved the original license becomes VOID and is ILLEGAL for use.
Indicate what happened to the license(s)
Lost
Not Received In The Mail
Stolen
Damaged
Provide a fax number or email address below for this form to be returned to for immediate use for fishing:
Fax Number: ________________________________
Email Address: __________________________________
FEE
Permit Card:
______________
______________________
______________________________________
_________________
$20.00
CFEC FISHERY
PERMIT NUMBER/ALPHA
CFEC USE ONLY/YEAR/SEQUENCE/ALPHA
ADFG NUMBER
Permit Card:
______________
______________________
______________________________________
_________________
$20.00
CFEC FISHERY
PERMIT NUMBER/ALPHA
CFEC USE ONLY/YEAR/SEQUENCE/ALPHA
ADFG NUMBER
Vessel Triangle Metal Plate:
______________
_________________________ ______________________________ _______________
$20.00
ADFG NUMBER VESSEL NAME
USCG OR REGISTRATION NUMBER OVERALL LENGTH
Vessel License Receipt:
______________
_________________________ ______________________________ _______________
$20.00*
ADFG NUMBER
VESSEL NAME
USCG OR REGISTRATION NUMBER OVERALL LENGTH
Vessel Sticker:
______________
_________________________ ______________________________ _______________
$20.00*
ADFG NUMBER
VESSEL NAME
USCG OR REGISTRATION NUMBER OVERALL LENGTH
* Please note that if you are applying for a duplicate vessel license and sticker there is only one $20 fee required.
Salmon Net Area Tab:
________________ NO FEE
AREA
Certification:
Other (explain) ________________
I certify that I am the:
Permit holder
Vessel owner
*Agent or representative
____________________________________________________
___________________________
Signature of Applicant
Date
*Authorization must be attached if signed or picked-up by someone else
Subscribed and sworn to before me this___________ day of ________________, 20___ at ____________________
___________________________________________
__________________
Notary Public (or Postmaster in Alaska)
Commission expires
CFEC staff must authorize the permit holder and/or vessel operator to begin fishing with a copy of this page. If it is after business
hours, please send an email to dfg.cfec.licensing@alaska.gov. Once the email is received a determination will be made and you will be
contacted as soon as possible.
________________________________________________________________________________________ __________________ __________________
Signature
Name and Title
Date Valid
Valid Through
PAGE 1
Revised November 2019
Form # 05-15A
PO Box 110302
Commercial Fisheries Entry Commission
Juneau, AK 99811-0302
Phone: 907-789-6150
Request for Duplicate Licenses
Toll-Free: 1-855-789-6150
Fax: 907-789-6170
www.cfec.state.ak.us
Please use this form to request a replacement permit card, vessel triangle metal plate, vessel license receipt or a vessel license sticker if the
original issued license for the current calendar year has been lost, not received in the mail, stolen or damaged. This form must be signed,
notarized and mailed/faxed to the Commercial Fisheries Entry Commission (CFEC) with the appropriate fees. Please submit payment by
check, money order or use the attached credit card authorization. All sections of this form must be complete to avoid delays in processing.
Applicant Information:
Applicant’s Name: __________________________________________
CFEC ID#: _________________
Date of Birth ___________
Permanent Mailing Address: ______________________________________________________________________________________
City: _______________________ State: ______ Zip: ___________ Phone Number: _____________________ Check if Unlisted
_____
Temporary Mailing Address (for these licenses): ______________________________________________________________________
City: _______________________ State: ______ Zip: ___________
License Information:
When the duplicate is approved the original license becomes VOID and is ILLEGAL for use.
Indicate what happened to the license(s)
Lost
Not Received In The Mail
Stolen
Damaged
Provide a fax number or email address below for this form to be returned to for immediate use for fishing:
Fax Number: ________________________________
Email Address: __________________________________
FEE
Permit Card:
______________
______________________
______________________________________
_________________
$20.00
CFEC FISHERY
PERMIT NUMBER/ALPHA
CFEC USE ONLY/YEAR/SEQUENCE/ALPHA
ADFG NUMBER
Permit Card:
______________
______________________
______________________________________
_________________
$20.00
CFEC FISHERY
PERMIT NUMBER/ALPHA
CFEC USE ONLY/YEAR/SEQUENCE/ALPHA
ADFG NUMBER
Vessel Triangle Metal Plate:
______________
_________________________ ______________________________ _______________
$20.00
ADFG NUMBER VESSEL NAME
USCG OR REGISTRATION NUMBER OVERALL LENGTH
Vessel License Receipt:
______________
_________________________ ______________________________ _______________
$20.00*
ADFG NUMBER
VESSEL NAME
USCG OR REGISTRATION NUMBER OVERALL LENGTH
Vessel Sticker:
______________
_________________________ ______________________________ _______________
$20.00*
ADFG NUMBER
VESSEL NAME
USCG OR REGISTRATION NUMBER OVERALL LENGTH
* Please note that if you are applying for a duplicate vessel license and sticker there is only one $20 fee required.
Salmon Net Area Tab:
________________ NO FEE
AREA
Certification:
Other (explain) ________________
I certify that I am the:
Permit holder
Vessel owner
*Agent or representative
____________________________________________________
___________________________
Signature of Applicant
Date
*Authorization must be attached if signed or picked-up by someone else
Subscribed and sworn to before me this___________ day of ________________, 20___ at ____________________
___________________________________________
__________________
Notary Public (or Postmaster in Alaska)
Commission expires
CFEC staff must authorize the permit holder and/or vessel operator to begin fishing with a copy of this page. If it is after business
hours, please send an email to dfg.cfec.licensing@alaska.gov. Once the email is received a determination will be made and you will be
contacted as soon as possible.
________________________________________________________________________________________ __________________ __________________
Signature
Name and Title
Date Valid
Valid Through
PAGE 1
Revised November 2019
Form # 05-15A
PO Box 110302
Commercial Fisheries Entry Commission
Juneau, AK 99811-0302
Phone: 907-789-6150
Credit Card Authorization
Toll-Free: 1-855-789-6150
Fax: 907-789-6170
www.cfec.state.ak.us
I authorize the Commercial Fisheries Entry Commission (CFEC) to charge the card listed below. This
payment is only valid for the items and amount listed.
Please indicate the permit and/or vessel numbers in the space provided and the total amount you are
authorizing your card to be charged.
FEES TO BE CHARGED TO CARD
Item(s)
Enter Permit & Vessel Numbers
Fee Amount
Permit(s):
$
Vessel(s):
$
Transfer Fees ($50):
$
Duplicate Fees ($20):
$
Immediate Fishing ($80):
$
Check here to have your licenses express mailed
and that you agree to pay the current USPS express
mail rate PLUS the CFEC service fee of $15.00.
Total amount to be charged $
Name of Cardholder: _________________________________________________________
Cardholder Phone Number: __________________________
Cardholder Signature: ___________________________________ Date: ______________
Card type:
Visa
Mastercard
Discover
Expiration Date: _____ / _____
Credit Card #: _____________ - _____________ - _____________ - ____________
DO NOT EMAIL THIS FORM. PLEASE FAX OR MAIL FORM.
Revised November 2019
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