"Oklahoma Resident Lifetime License Application Form" - Oklahoma

Oklahoma Resident Lifetime License Application Form is a legal document that was released by the Oklahoma Department of Wildlife Conservation - a government authority operating within Oklahoma.

Form Details:

Released on July 1, 2014;
The latest edition currently provided by the Oklahoma Department of Wildlife Conservation;
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Street Address:

2145 NE 36

Mailing address:

P.O. Box 53465

Oklahoma City, OK 73111

Oklahoma City, OK 73152

(

405) 521-3852

OKLAHOMA RESIDENT LIFETIME LICENSE APPLICATION

Attn: Veterans who are certified as disabled by the V.A., please contact ODWC for a different application.

[ ] COMBINATION $775.00

Lifetime licenses are available only by mail or in person at ODWC headquarters in Oklahoma City. For

mail-in orders, please allow up to three weeks for processing. License may be purchased with a money order,

[ ] HUNTING $625.00

cashier’s check, credit card, or personal check. If you pay with a personal check, the LICENSE WILL BE HELD

[ ] FISHING $225.00

FOR THREE WEEKS. ** The Payment Plan Option is available to sportsmen under 18, with the first and last

payments requiring residency approval. Minimum payments are $25 and the balance of the license is due 12

[ ] Under Age 18 Payment Plan**

months from the date of the first payment. After 12 months, any prior payments will be forfeited.

Please Print or Type. Complete All Sections. Incomplete Applications will be returned.

FULL LEGAL NAME ___________________________________________________________________________________________________________________

Last Name

First Name

Middle Name

CURRENT ADDRESS __________________________________________________________________________________________________________________

CITY _________________________________________________ STATE ________ ZIP CODE _______________ COUNTY ______________________________

PERMANENT ADDRESS (if different than above) ____________________________________________________________________________________________

CITY _________________________________________________ STATE ________ ZIP CODE _______________ COUNTY ______________________________

YEARS AT CURRENT ADDRESS _____________

MILITARY VETERAN (Check One) ______ YES ______ NO

SOCIAL SECURITY NUMBER (REQUIRED) ______________________________________ DATE OF BIRTH (MM/DD/YYYY) ________/________/________

DRIVER’S LICENSE NUMBER ____________________________________ STATE ________ EXPIRATION DATE ____________ ISSUE DATE____________

HUNTER EDUCATION NUMBER ______________________________________

STATE CERTIFIED __________

(Required if age 30 or under for combination/hunting, or license will be issued with apprentice designation

(If other than Oklahoma, provide photocopy of certificate or card.)

TELEPHONE NUMBER (__________) ____________________________ EMAIL ADDRESS ________________________________________________________

PREVIOUS ADDRESS __________________________________________ CITY ___________________________ STATE __________ ZIP CODE ____________

DID YOU FILE OKLAHOMA INCOME TAXES LAST YEAR? (Check One) ______ YES ______ NO

IF NO, WHAT STATE? ________________________

OCCUPATION _________________________________________________________________ YEARS AT CURRENT EMPLOYER ________________________

EMPLOYER ___________________________________________________________________________________________________________________________

Name

Address

Telephone

*ANY FALSE STATEMENT OR FALSE INFORMATION MAY CONSTITUTE A MISDEMEANOR, FELONY OR OTHER BREACH OF LAW*

I certify under penalty of perjury under the laws of the state of Oklahoma that the above information is true and correct and that I, or the above applicant, has

been a bonafide permanent resident of Oklahoma, as defined in Title 29 of the Oklahoma State statutes, for six months immediately preceding the date of this

application and that the applicant intends to make Oklahoma his/her permanent place of residence.

X__________________________________________________

X___________________________________________________

Signature of Applicant or Preparer (if other than applicant) / Date

Signature of Authorized Department Employee / ID # / Date

Applicant must contact the County Game Warden or authorized Department of Wildlife employee for residency verification and domiciliary intent before mailing

application to Oklahoma City. To prove residency, please provide the following documents: Oklahoma Driver's License and Hunter Education card (if you are 30 years of

age or under). For those individuals who do not drive, residency can be approved with an Oklahoma ID card that is at least 6 months old. If you are under sixteen years of

age, a report card from an Oklahoma school or the parent’s latest Oklahoma tax return listing the child as a dependent will provide the required proof of residency.

*****************************************************************************************************************************

To charge this purchase to your Visa or MasterCard, complete the section below:

For Office Use Only – Resident Lifetime

___ VISA

___ MASTERCARD

___ DISCOVER

License #: _______________

Issued By: ________

Card Number: ________-________-________-________ Exp. Date: ____/____

Card Holder Name: ________________________________________________

Card Holder Address: _______________________________________________

Signature: ________________________________________________________

Rev. 07/2014

Street Address:

2145 NE 36

Mailing address:

P.O. Box 53465

Oklahoma City, OK 73111

Oklahoma City, OK 73152

(

405) 521-3852

OKLAHOMA RESIDENT LIFETIME LICENSE APPLICATION

Attn: Veterans who are certified as disabled by the V.A., please contact ODWC for a different application.

[ ] COMBINATION $775.00

Lifetime licenses are available only by mail or in person at ODWC headquarters in Oklahoma City. For

mail-in orders, please allow up to three weeks for processing. License may be purchased with a money order,

[ ] HUNTING $625.00

cashier’s check, credit card, or personal check. If you pay with a personal check, the LICENSE WILL BE HELD

[ ] FISHING $225.00

FOR THREE WEEKS. ** The Payment Plan Option is available to sportsmen under 18, with the first and last

payments requiring residency approval. Minimum payments are $25 and the balance of the license is due 12

[ ] Under Age 18 Payment Plan**

months from the date of the first payment. After 12 months, any prior payments will be forfeited.

Please Print or Type. Complete All Sections. Incomplete Applications will be returned.

FULL LEGAL NAME ___________________________________________________________________________________________________________________

Last Name

First Name

Middle Name

CURRENT ADDRESS __________________________________________________________________________________________________________________

CITY _________________________________________________ STATE ________ ZIP CODE _______________ COUNTY ______________________________

PERMANENT ADDRESS (if different than above) ____________________________________________________________________________________________

CITY _________________________________________________ STATE ________ ZIP CODE _______________ COUNTY ______________________________

YEARS AT CURRENT ADDRESS _____________

MILITARY VETERAN (Check One) ______ YES ______ NO

SOCIAL SECURITY NUMBER (REQUIRED) ______________________________________ DATE OF BIRTH (MM/DD/YYYY) ________/________/________

DRIVER’S LICENSE NUMBER ____________________________________ STATE ________ EXPIRATION DATE ____________ ISSUE DATE____________

HUNTER EDUCATION NUMBER ______________________________________

STATE CERTIFIED __________

(Required if age 30 or under for combination/hunting, or license will be issued with apprentice designation

(If other than Oklahoma, provide photocopy of certificate or card.)

TELEPHONE NUMBER (__________) ____________________________ EMAIL ADDRESS ________________________________________________________

PREVIOUS ADDRESS __________________________________________ CITY ___________________________ STATE __________ ZIP CODE ____________

DID YOU FILE OKLAHOMA INCOME TAXES LAST YEAR? (Check One) ______ YES ______ NO

IF NO, WHAT STATE? ________________________

OCCUPATION _________________________________________________________________ YEARS AT CURRENT EMPLOYER ________________________

EMPLOYER ___________________________________________________________________________________________________________________________

Name

Address

Telephone

*ANY FALSE STATEMENT OR FALSE INFORMATION MAY CONSTITUTE A MISDEMEANOR, FELONY OR OTHER BREACH OF LAW*

I certify under penalty of perjury under the laws of the state of Oklahoma that the above information is true and correct and that I, or the above applicant, has

been a bonafide permanent resident of Oklahoma, as defined in Title 29 of the Oklahoma State statutes, for six months immediately preceding the date of this

application and that the applicant intends to make Oklahoma his/her permanent place of residence.

X__________________________________________________

X___________________________________________________

Signature of Applicant or Preparer (if other than applicant) / Date

Signature of Authorized Department Employee / ID # / Date

Applicant must contact the County Game Warden or authorized Department of Wildlife employee for residency verification and domiciliary intent before mailing

application to Oklahoma City. To prove residency, please provide the following documents: Oklahoma Driver's License and Hunter Education card (if you are 30 years of

age or under). For those individuals who do not drive, residency can be approved with an Oklahoma ID card that is at least 6 months old. If you are under sixteen years of

age, a report card from an Oklahoma school or the parent’s latest Oklahoma tax return listing the child as a dependent will provide the required proof of residency.

*****************************************************************************************************************************

To charge this purchase to your Visa or MasterCard, complete the section below:

For Office Use Only – Resident Lifetime

___ VISA

___ MASTERCARD

___ DISCOVER

License #: _______________

Issued By: ________

Card Number: ________-________-________-________ Exp. Date: ____/____

Card Holder Name: ________________________________________________

Card Holder Address: _______________________________________________

Signature: ________________________________________________________