Colorado License Information Form

Colorado License Information Form Name: Address: City: State: Zip: State Drivers License No.: Email: Telephone: (home) (work) Date of Birth: Social Security No.: Height: Weight: Hair Color: Eye Color: Hunter Education No*: CID# (Customer I.D. Number)**:

1* If you were born after 1948. Please furnish us with a photocopy of your Hunter Safety Card if the HUNTER EDUCATION RULES apply to you. We cannot get your license without it. 2* You cannot hunt without your License/Carcass Tag and Hunter Safety Card on your person while in the field. Attach a check, made payable to SIERRA GRANDE OUTFITTERS, INC., (“SGO, INC.”); according the specie you are hunting (send one check for the total amount if hunting more than one specie). This year, we are implementing a charge to enable us to recover some of the costs associated with getting your license. A $50 fee will be assessed for draw applications and/or a $20 fee will be assessed for over-the counter (OTC) licenses. Fees also include the $10 State of Colorado Habitat Stamp.

SPECIE DRAW Deer $ 429.00 Elk $ 689.00 Antelope $ 429.00 Bear $ 414.00 Moose/Sheep/Goat $2,134.00

Return information and check to: SIERRA GRANDE OUTFITTERS, INC. PO Box 269 Florissant, CO 80816-0269 Colorado License #1006

In order to simplify and expedite the license application process, we prefer to use this Limited Power of Attorney Form. This enables us to complete your application, sign it for you, and then submit it, by the deadline, to the appropriate State Game Department. If you are unsuccessful in the lottery drawing, the refund check will be sent back to you.

LIMITED POWER OF ATTORNEY I, , authorize Leslie D. Ezell, President, Sierra Grande Outfitters, Inc., to sign my permit application for the special hunts for which I have provided a check for the license fees.

Hunter Signature: ______

NOTARY PUBLIC The above document was acknowledged before me by this day of ______, 2016. My Commission Expires: Notary Public – State of ______

Sierra Grande Outfitters · PO Box 269 · Florissant, CO 80816 · 719-748-1010 or 719-748-8179 (fax)