"Outfitter Application or Renewal Form" - New Mexico

Outfitter Application or Renewal Form is a legal document that was released by the New Mexico Department of Game & Fish - a government authority operating within New Mexico.

Form Details:

  • Released on December 1, 2017;
  • The latest edition currently provided by the New Mexico Department of Game & Fish;
  • 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 New Mexico Department of Game & Fish.

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OUTFITTER APPLICATION OR RENEWAL FORM
FOR DEPT. USE ONLY
Payment Type/#_______________
Amount $____________________
Date_______/_______/_________
Application Fee: $500.00
Initials______________________
Payable to the NM Game & Fish
□ Exam Score ________________
NEW MEXICO DEPARTMENT OF GAME & FISH
Add $100.00 late fee
between
□ Valid Insurance Policy________
FIELD OPERATIONS DIVISION
Feb. 16 - March 15 if you are renewing
□ Tax & Rev Compliance _______
GUIDE & OUTFITTER PROGRAM
for the NM Outfitter 10% pool.
□ History of Violation __________
P.O. BOX 25112
□ Checklist for 10% Pool________
SANTA FE, NM 87504
□ Outfitter Card Issued__________
505-476-8066 / Fax 505-476-8133
Email:
DGF-Guide-Outfitter@state.nm.us
NEW APPLICATION
RENEWAL Outfitter Number: O - __ __ __ __
BUSINESS NAME
ADDRESS
(mailing)
ADDRESS
(physical)
CITY, STATE, ZIP
BUSINESS PHONE
EMAIL
BUSINESS WEBSITE
FULL NAME
CELL NO.
(First, Middle Initial, Last)
DATE OF BIRTH
SOCIAL SECURITY NO.
DRIVERS LICENSE NO.
DRIVERS LICENSE STATE
EYE
HAIR
HEIGHT
WEIGHT
COLOR
COLOR
Are you a New Mexico resident? Yes or No
YES
NO
If yes, date of NM residency
INSURANCE INFORMATION
POLICY NUMBER
START DATE
END DATE
NM TAXATION & REVENUE INFORMATION can be found on your NM Tax & Rev registration certificate
Business’ Registered as Corp., LLC, Inc., etc., update below
Business’ Registered as a Sole Proprietor, update below
C.R.S. NUMBER
C.R.S. NUMBER
Identification Number
Identification Number
BUSINESS ZIP CODE
ZIP CODE
FEIN #
(Last 4 digits only)
SSN
(Last 4 digits only)
Federal Employer Identification #
New Mexico Department of Game & Fish ● Guide & Outfitter Program ● Revised December 2017
Page 1 of 5
OUTFITTER APPLICATION OR RENEWAL FORM
FOR DEPT. USE ONLY
Payment Type/#_______________
Amount $____________________
Date_______/_______/_________
Application Fee: $500.00
Initials______________________
Payable to the NM Game & Fish
□ Exam Score ________________
NEW MEXICO DEPARTMENT OF GAME & FISH
Add $100.00 late fee
between
□ Valid Insurance Policy________
FIELD OPERATIONS DIVISION
Feb. 16 - March 15 if you are renewing
□ Tax & Rev Compliance _______
GUIDE & OUTFITTER PROGRAM
for the NM Outfitter 10% pool.
□ History of Violation __________
P.O. BOX 25112
□ Checklist for 10% Pool________
SANTA FE, NM 87504
□ Outfitter Card Issued__________
505-476-8066 / Fax 505-476-8133
Email:
DGF-Guide-Outfitter@state.nm.us
NEW APPLICATION
RENEWAL Outfitter Number: O - __ __ __ __
BUSINESS NAME
ADDRESS
(mailing)
ADDRESS
(physical)
CITY, STATE, ZIP
BUSINESS PHONE
EMAIL
BUSINESS WEBSITE
FULL NAME
CELL NO.
(First, Middle Initial, Last)
DATE OF BIRTH
SOCIAL SECURITY NO.
DRIVERS LICENSE NO.
DRIVERS LICENSE STATE
EYE
HAIR
HEIGHT
WEIGHT
COLOR
COLOR
Are you a New Mexico resident? Yes or No
YES
NO
If yes, date of NM residency
INSURANCE INFORMATION
POLICY NUMBER
START DATE
END DATE
NM TAXATION & REVENUE INFORMATION can be found on your NM Tax & Rev registration certificate
Business’ Registered as Corp., LLC, Inc., etc., update below
Business’ Registered as a Sole Proprietor, update below
C.R.S. NUMBER
C.R.S. NUMBER
Identification Number
Identification Number
BUSINESS ZIP CODE
ZIP CODE
FEIN #
(Last 4 digits only)
SSN
(Last 4 digits only)
Federal Employer Identification #
New Mexico Department of Game & Fish ● Guide & Outfitter Program ● Revised December 2017
Page 1 of 5
AFFIDAVIT:
By submitting this application to become a New Mexico Registered Outfitter, I attest to its accuracy and
declare that I have not been convicted of a felony or have a history of violation from any law
enforcement agency for violation(s) of hunting, fishing, trapping, outfitting or guiding rules or land-use
regulations, including any conviction as an accessory, during the three-year period immediately
preceding the application for registration. I understand that making false statements or failure to disclose
material facts will result in denial and voidance of registration. I am aware that failure to successfully
complete this application may result in a processing delay and/or its rejection.
YES
NO
For the following questions, write
or
in the corresponding boxes and explain the details. If yes, you are required to
disclose the details of any alleged violations, convictions, revocations, and/or suspensions. You may attach a separate sheet with
details and copies of any relevant documentation.
In the past three years, have you been charged
with (received a citation or ticket) or convicted
of any violations of any local, state and federal
laws and regulations pertaining to wildlife,
hunting, fishing, trapping, guiding, outfitting,
trespass, land-use or off highway vehicle?
Have you ever had a hunting, fishing, trapping,
guide or outfitter license, registration, permit,
authorization or certificate revoked or
suspended in ANY state?
If yes, explain the details, including state.
Misrepresentation or failure to disclose information on an application constitutes misconduct and will result in your
registration being denied and/or subject to revocation.
AUTHORIZATION FOR RELEASE OF INFORMATION:
Pursuant to the Arrest Record Information Act, Subsection A of Section 29-10-6 NMSA 1978:
I hereby appoint New Mexico Department of Game and Fish as an authorized agent for me, for
the purpose of inspecting and/or obtaining copies of any New Mexico arrest fingerprint card supported
arrest record information maintained by the Department of Public Safety, including information
concerning felony or misdemeanor arrests and information obtained from relevant fingerprint
databases.
To the custodian of the records in question, I hereby direct you to release such information to the
authorized agent as described above.
I hereby release the custodian(s) of such records and the Department of Public Safety, including any of
their agents, employees or representatives in any capacity from any and all claims of liability or
damage of whatever kind or nature, which at any time could result to me. My heirs, assigns, associates,
personal representative(s) of any nature because of compliance by said custodian(s) with this
“Authorization for Release of Information” and my request contained herein for this release is binding,
now and in the future and is valid for a period of up to 120 days from the date signed, on my heirs,
assigns, associates, personal representative(s) of any nature.
__________________________________________
__________________________
Signature of Outfitter or Applicant
Date
New Mexico Department of Game & Fish ● Guide & Outfitter Program ● Revised December 2017
Page 2 of 5
NM OUTFITTER 10% SPECIAL DRAWING POOL
MANDATORY CHECKLIST
NEW MEXICO DEPARTMENT OF GAME & FISH
FIELD OPERATIONS DIVISION
GUIDE & OUTFITTER PROGRAM
P.O. BOX 25112
SANTA FE, NM 87504
505-476-8066 / Fax 505-476-8133
Email:
DGF-Guide-Outfitter@state.nm.us
Please verify that you qualify as a New Mexico Outfitter as per the requirements and restrictions established in statutes 17-3-
16, 17-2A-1 NMSA 1978 and regulation 19.30.8 NMAC. Each outfitter must be able to prove whether they are an
incorporated business or sole proprietor to be in the NM Outfitter 10% Special Drawing Pool.
All outfitter businesses that are incorporated: Corp., LLC, Inc., etc…
SECTION 1:
I verify that I have the following documents on file as a NM
Initial
,
each box
Outfitter, meaning a person who has a business:
Print Full Name
with a valid New Mexico state, county or municipal business registration and a valid outfitter license issued by the
department of game and fish;
that is authorized to do and is doing outfitting business under the laws of this state;
that has paid property taxes or rent on real property in New Mexico, paid gross receipts taxes and paid at least one other
tax administered by the taxation and revenue department in each of the three years immediately preceding the
submission of an affidavit to the department of game and fish;
the majority of which is owned by the person who has resided in New Mexico during the three-year period immediately
preceding the submission of an affidavit to the department of game and fish;
that employs at least eighty percent of the total personnel of the business who are New Mexico residents; and
that has either leased property for ten years or purchased property greater than fifty thousand dollars ($50,000) in value
in New Mexico;
that, if it has changed its name from that of a previously certified business, the business is identical in every way to the
previously certified business that meets all criteria;
that possesses all required federal or state land use permits for the hunt; and
that operates as a hunting guide service during which at least two days are accompanied with the client in the area where
the license is valid.
SECTION 2:
Outfitter businesses that are unincorporated sole proprietorships. Outfitters must submit to the department New
Mexico Taxation and Revenue paperwork and insurance that show they are sole proprietors in their individual name. Outfitters
must advertise and sign contracts as a sole proprietor.
I verify that I have the following documents on file as a NM
Initial
,
each box
Outfitter, meaning a person who has a business:
Print Full Name
with a valid New Mexico state, county or municipal business registration and a valid outfitter license issued by the
department of game and fish;
that is authorized to do and is doing outfitting business under the laws of this state;
that, if it has changed its name from that of a previously certified business, the business is identical in every way to the
previously certified business that meets all criteria;
that possesses all required federal or state land use permits for the hunt; and
that operates as a hunting guide service during which at least two days are accompanied with the client in the area where
the license is valid.
Please note that documentation may be requested at any time by the department to verify that you meet requirements.
AFFIDAVIT:
I attest that the statements made herein are true and accurate and declare that I am qualified to be a “New Mexico
Outfitter in the 10% pool as per 17-3-16, 17-2A-1 and 17-2A-3 NMSA 1978 and regulation 19.30.8 NMAC.
Signature of Outfitter Applicant
Date
New Mexico Department of Game & Fish ● Guide & Outfitter Program ● Revised December 2017
Page 3 of 5
In an effort to update our records and provide your clientele (hunter-clients) with accurate and useful information, please complete the following.
WHAT AREAS DO YOU SPECIALIZE IN OUTFITTING? Circle or check all that apply
NW
NE
SW
SE
Statewide
or
Quadrant
Quadrant
Quadrant
Quadrant
WHAT GMU’S DO YOU GUIDE AND OUTFIT IN? Circle or check all that apply
2A
2B
2C
4
5A
5B
6A
6B
6C
7
8
9
10
12
13
14
15
16A
16B
16C
16D
16E
17
18
19
20
21A
21B
22
23
24
25
26
27
28
29
30
31
32
33
34
36
37
38
39
40
41
42
43
45
46
47
48
49
50
55B
51A
51B
52
53
54
55A
56
57
58
59
WHAT SPECIES OF GAME DO YOU SPECIALIZE IN OUTFITTING? Circle or check all that apply
Elk
Ibex
Rocky Mountain Bighorn Sheep
Bear
Deer
Oryx
Desert Bighorn Sheep
Lion
Pronghorn Antelope
Javelina
Barbary Sheep
Other
LIST YOUR CURRENT FEDERAL AND/OR STATE LAND USE PERMIT NUMBER NEXT TO APPROPRIATE AREA
STATE LAND OFFICE PERMIT NUMBER
FOREST SERVICE PERMIT NUMBER
SPECIFIC RANGER DISTRICTS
Carson
Cibola
Gila
Lincoln
Santa Fe
BLM PERMIT NUMBER
SPECIFIC AREAS
BUREAU OF LAND MANAGEMENT
Carlsbad
Farmington
Las Cruces
Rio Puerco
Roswell
Socorro
Taos
New Mexico Department of Game & Fish ● Guide & Outfitter Program ● Revised December 2017
Page 4 of 5
OUTFITTER APPLICATION OR RENEWAL REQUIREMENTS
NEW MEXICO DEPARTMENT OF GAME & FISH
FIELD OPERATIONS DIVISION
GUIDE & OUTFITTER PROGRAM
P.O. BOX 25112
SANTA FE, NM 87504
505-476-8066 / Fax 505-476-8133
Email:
DGF-Guide-Outfitter@state.nm.us
ALL OUTFITTER RENEWALS MUST REMIT:
$500.00 fee payable to NMDGF ($600.00 fee is only applied for the late fee to be included in the
NM Outfitter 10% special draw pool between the period of Feb. 16-March 15.)
A “Certificate of Liability Insurance” minimum aggregate for each occurrence of $500,000.00
ALL NEW OUTFITTER APPLICANTS MUST REMIT WITH THIS APPLICATION:
$500.00 fee payable to NMDGF ($600.00 fee is only applied for the late fee to be included in the
NM Outfitter pool between the period of Feb. 16-March 15.)
At least three years as a New Mexico registered guide, a registered guide shall work only under the
supervision of a New Mexico registered outfitter. Copies of documents showing three years of
actual guiding experience (ex. Federal land use permits, business or employment records from
the outfitter) and a letter from said New Mexico registered outfitter attesting to your experience.
A copy of your county or city/municipal business registration or license.
A copy of your registration with New Mexico Taxation and Revenue.
A “Certificate of Liability Insurance” minimum aggregate for each occurrence of $500,000.00
A copy of your Hunter Education (Safety) card.
A copy of certificate of completion of “NM Guide & Outfitter Examination” (only if the original
proof of exam is not already with the Guide & Outfitter Program).
New Mexico Department of Game & Fish ● Guide & Outfitter Program ● Revised December 2017
Page 5 of 5