"Application for a Permanent Pennsylvania Boating Safety Education Certificate" - Pennsylvania

Application for a Permanent Pennsylvania Boating Safety Education Certificate is a legal document that was released by the Pennsylvania Fish and Boat Commission - a government authority operating within Pennsylvania.

Form Details:

  • Released on June 1, 2017;
  • The latest edition currently provided by the Pennsylvania Fish and Boat Commission;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Pennsylvania Fish and Boat Commission.

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APPLICATION FOR A PERMANENT
PENNSYLVANIA BOATING SAFETY EDUCATION CERTIFICATE
Please check the appropriate box and follow the instructions below.
TEMPORARY to PERMANENT ($10) – To convert a temporary PFBC (PA Fish & Boat Commission) certificate
to a permanent certificate, submit this form, a copy of your temporary certificate, and payment.
DUPLICATE or REPLACEMENT ($5) – To apply for a duplicate or replacement PFBC certificate, submit this form
and payment. (This selection is only for persons who have previously been issued permanent PFBC certificates).
OTHER CERTIFICATIONS ($10) – To convert a U.S. Coast Guard Auxiliary, U.S. Power Squadron, or other
course approved by the National Association of State Boating Law Administrators (NASBLA) to a PFBC
Boating Safety Education Certificate, submit this form, your current certificate, and payment. Include a self-
addressed, stamped envelope if you want your current certificate returned.
Processing and delivery of permanent cards may take 30 to 40 days. Should you not receive a permanent card
within that time frame, contact the PFBC immediately at 888-723-4741. Please note that temporary PFBC Boating
Safety Education Certificates are valid for only 60 days from the date of issue.
CURRENT INFORMATION
(
Please PRINT)
PA Certificate No.
(Leave blank if not known)
#
NAME
Last:
First:
Middle Initial:
MAILING ADDRESS
Street or P.O. Box No.
CITY/STATE/ZIP
City:
State:
Zip Code:
DAYTIME
BIRTH DATE
(
)
-
PHONE
MM/DD/YYYY
PLEASE CHECK
THE APPROPRIATE SELECTION IN EACH COLUMN
(choose only one each)
Hair Color
Eye Color
Gender
Brown
Brown
Male
Blond
Green
Female
Gray
Blue
Black
Gray
Red
Other
Other
Number of Certificates Ordered: ______________
Payment: $_______________
(Do Not Send Cash)
Check or Money Order #_______________________________ (Payable to PA Fish & Boat Commission)
Credit Card # _______________________________________________
Exp.
_________________
Date (ex. 04/2017)
(Discover / MasterCard / Visa)
Mail to:
PA Fish & Boat Commission
Boating Safety Education
PO Box 67000
Harrisburg, PA 17106-7000
I hereby certify, under penalty of law, that the foregoing information is true and correct to the best of
my knowledge, information and belief. I understand that submission of false information in
connection with this official application may be subject to criminal penalties under 18 Pa. C.S. Ch. 49
and 30 PA. C.S. Ch. 9.
___________________________________________________________________________________
Applicant’s Signature or Parental Signature if Applicant is Younger than 18 Years of Age
Rev: 6.2017
APPLICATION FOR A PERMANENT
PENNSYLVANIA BOATING SAFETY EDUCATION CERTIFICATE
Please check the appropriate box and follow the instructions below.
TEMPORARY to PERMANENT ($10) – To convert a temporary PFBC (PA Fish & Boat Commission) certificate
to a permanent certificate, submit this form, a copy of your temporary certificate, and payment.
DUPLICATE or REPLACEMENT ($5) – To apply for a duplicate or replacement PFBC certificate, submit this form
and payment. (This selection is only for persons who have previously been issued permanent PFBC certificates).
OTHER CERTIFICATIONS ($10) – To convert a U.S. Coast Guard Auxiliary, U.S. Power Squadron, or other
course approved by the National Association of State Boating Law Administrators (NASBLA) to a PFBC
Boating Safety Education Certificate, submit this form, your current certificate, and payment. Include a self-
addressed, stamped envelope if you want your current certificate returned.
Processing and delivery of permanent cards may take 30 to 40 days. Should you not receive a permanent card
within that time frame, contact the PFBC immediately at 888-723-4741. Please note that temporary PFBC Boating
Safety Education Certificates are valid for only 60 days from the date of issue.
CURRENT INFORMATION
(
Please PRINT)
PA Certificate No.
(Leave blank if not known)
#
NAME
Last:
First:
Middle Initial:
MAILING ADDRESS
Street or P.O. Box No.
CITY/STATE/ZIP
City:
State:
Zip Code:
DAYTIME
BIRTH DATE
(
)
-
PHONE
MM/DD/YYYY
PLEASE CHECK
THE APPROPRIATE SELECTION IN EACH COLUMN
(choose only one each)
Hair Color
Eye Color
Gender
Brown
Brown
Male
Blond
Green
Female
Gray
Blue
Black
Gray
Red
Other
Other
Number of Certificates Ordered: ______________
Payment: $_______________
(Do Not Send Cash)
Check or Money Order #_______________________________ (Payable to PA Fish & Boat Commission)
Credit Card # _______________________________________________
Exp.
_________________
Date (ex. 04/2017)
(Discover / MasterCard / Visa)
Mail to:
PA Fish & Boat Commission
Boating Safety Education
PO Box 67000
Harrisburg, PA 17106-7000
I hereby certify, under penalty of law, that the foregoing information is true and correct to the best of
my knowledge, information and belief. I understand that submission of false information in
connection with this official application may be subject to criminal penalties under 18 Pa. C.S. Ch. 49
and 30 PA. C.S. Ch. 9.
___________________________________________________________________________________
Applicant’s Signature or Parental Signature if Applicant is Younger than 18 Years of Age
Rev: 6.2017