APPLICATION Lifetime Hunting & Fishing License for Resident Disabled Veterans This license shall be issued only to an individual resident of North Carolina who is a fifty percent or more disabled veteran as determined by the U.S. Department of Veterans Affairs, remaining valid for the lifetime of the individual so long as the individual remains fifty percent or more disabled. Certification from the Department of Veterans Affairs must be submitted with this application.

Applicant’s Name: Telephone # ( ) First Middle Last

Resident Address: Street City State Zip Code Mailing Address (if different from above): Street or PO Box City State Zip Code

Birth Date: NC Driver License # WRC Customer # (if available)

Email Address:

Are you certified by the Dept. of Veterans Affairs as a 50% or more disabled veteran? Yes If yes, attach a copy of the Certification. No If no, you must obtain this Certification prior to applying. Incomplete applications and those received without proper VA documentation will be returned.

Check Appropriate Box(s) Lifetime Disabled Veteran Fishing Only Licenses

Inland Fishing (basic) – Statewide inland fishing. Includes fishing in designated Public Mountain Trout Waters, fishing in trout waters on ...... $10 game lands, and fishing in joint waters. It does not include fishing in coastal waters. Coastal Recreational Fishing – Authorizes fishing in coastal and joint waters. It does not authorize fishing in inland waters...... $10

Lifetime Disabled Veteran Hunting & Fishing Licenses Hunting/Inland Fishing Combo (basic) – Statewide basic hunting and inland fishing. Includes fishing in designated Public Mountain Trout ...... $10 Waters, fishing in trout waters on game lands, and fishing in joint waters. It does not include fishing in coastal waters.

Sportsman – Statewide hunting and inland fishing. Includes hunting for big game, hunting on game lands, hunting for waterfowl (does not include ...... $100 the bear management e-stamp or federal duck stamp), fishing in designated Public Mountain Trout Waters, fishing in trout waters on game lands, and fishing in joint waters. It does not include fishing in coastal waters.

Sportsman/Coastal Recreational Fishing – Statewide hunting, inland and coastal recreational fishing. Includes hunting for big game, hunting on ...... $110 game lands, hunting for waterfowl (does not include the bear management e-stamp or federal duck stamp), fishing in designated Public Mountain Trout Waters, fishing in trout waters on game lands, and fishing in joint waters.

Bear Management E-Stamp – This electronic stamp is required to hunt bear. This e-stamp must be purchased annually, if hunting bear...... $10

Federal Duck Stamp – This stamp is required for waterfowl hunters 16 years of age and older. This stamp expires June 30 of each year……………....$26.50

Purchase Subtotal $ Plus Transaction Fee $ 2.00* Purchase Total $ *Transaction fee mandated by NCGS 113-270.1B.

COMPLETE THIS SECTION IF YOU ARE APPLYING FOR A LICENSE WITH HUNTING PRIVILEGES. Unless otherwise indicated below, a person may not purchase a hunting license or hunt in NC without having a Certificate of Competency for completing a hunter education course or had a NC hunting license effective prior to July 1, 2013. Check one of the following: I have had a North Carolina hunting license effective prior to July 1, 2013. I have successfully completed a hunter education course. Hunter Education Certificate Number: I have NOT successfully completed a hunter education course and understand that until I do so, when hunting I must be accompanied by an adult 18 years of age or older who is properly licensed to hunt in North Carolina. “Accompanied” is defined as maintaining a proximity to the hunter, which enables the adult to monitor the activities of the hunter by remaining within sight and hearing distance at all times without the use of electronic devices.

I certify that all information provided on this application is true and accurate and understand that providing false information to obtain a license is a Class 1 misdemeanor. Signature Date Mail application and fee (payable to NCWRC) to: North Carolina Wildlife Resources Commission

Transactions are not considered final until the check has cleared the bank. Items purchased License Section with a returned check will be made invalid. A Service Charge of up to $25 will be charged on 1707 Mail Service Center returned checks (G.S. 25-3-506). Raleigh, NC 27699-1700

Call for priority mail (UPS, Fed. Ex.) Instructions Office Location: NCSU Centennial Campus, 1751 Varsity Drive, Raleigh, NC Telephone: 1-888-248-6834 Website: www.ncwildlife.org Revised 08/2015