Application for Texas Resident Lifetime License

Application for Texas Resident Lifetime License Send completed application form, supporting documents and proper fee to: Texas Parks and Wildlife Department (TPWD), 4200 Smith School Road, Austin, Texas 78744. For additional information concerning Lifetime Licenses call toll-free 1-800-792-1112, #4820# or direct (512) 389-4820.

SECTION 1: ITEM

Resident Lifetime Super Combination Hunting and All-Water Fishing License (980) $1,800.00 Includes a Resident Hunting License, a Resident Fishing License and five state endorsements (archery, freshwater fishing, saltwater fishing with a red drum tag, upland game bird, and migratory game bird).

Resident Lifetime Hunting License (981) $1,000.00 Includes a Resident Hunting License and three state endorsements (archery, upland game bird, and migratory game bird).

Resident Lifetime Fishing License (982) $1,000.00 Includes a Resident Fishing License and two state endorsements (freshwater fishing and saltwater fishing with a red drum tag).

Resident Lifetime Hunting License to Combination Upgrade (983) $800.00 Upgrades from a Lifetime Hunting License to include a Resident Fishing License and two state endorsements (freshwater fishing and saltwater fishing with a red drum tag).

Resident Lifetime Fishing License to Combination Upgrade (984) $800.00 Upgrades from a Lifetime Fishing License to include a Resident Hunting License and three state endorsements (archery, upland game bird, and migratory game bird).

I wish to donate to the Veterans Fund. $1.00 $5.00 $10.00 $20.00 No Thanks

I wish to help feed hungry Texas families with a donation to Hunters for the Hungry. $1.00 $5.00 $10.00 $20.00 No Thanks

I wish to make a tax-deductible contribution to the Parks and Wildlife Lifetime License Endowment Fund. $ ______

SECTION 2: PAYMENT

Check Money Order Credit Card: Visa Master Card Discover TOTAL $ ______

Name on Credit Card: ______Daytime Phone: ______

Address: ______City ______State ______Zip ______

Card Number: ______Expires (month/year): ______

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Texas Parks and Wildlife Department maintains the information collected through this form. With few exceptions, you are entitled to be informed about the information we collect. Under Sections 552.021 and 552.023 of the Texas Government Code, you are also entitled to receive and review the information. Under Section 559.004, you are also entitled to have this information corrected.

PWD 0552 – A0900 (2/21) PAGE 1 OF 2 SECTION 3: APPLICANT REQUIREMENTS Important: (1) Applicants 17 years of age or older are required to attach a copy of their valid Texas driver’s license or personal identification card issued by the Texas Department of Public Safety; (2) If applicant holds a current year license including the same privileges (hunting, fishing or combination) as being applied for, then theoriginal current year license must be surrendered to TPWD along with this application; (3) The applicant must have been a resident of Texas more than six months immediately before applying for this lifetime license; (4) Applicant understands that lifetime licenses may be suspended or revoked in accordance with Parks and Wildlife Code 12.501; and (5) Additional fees for hunting and/or fishing privileges may be required in the future.

Applicant Name Last: ______Suffix: _____ First: ______Middle: ______

Physical Address: ______City: ______TX Zip: ______

Mailing Address: ______City: ______TX Zip: ______

Email Address: ______Phone: ______

Physical Description: Male Female Height (feet/inches): ______Eye Color: ______Hair Color: ______Date of Birth (mm/dd/yyyy): ______

Texas Driver’s License Number or Personal Identification Number: ______

Social Security Number (required by federal law if over 13 years of age): ______SECTION 4: REQUIRED SIGNATURE Falsifying information on documents is a punishable offense. Any person who knowingly makes a false entry in, or a false alteration of a governmental record is subject to criminal prosecution. I hereby certify that I as the applicant, or the person to whom I intend to gift this lifetime license, have/has resided continuously in Texas for more than the six months immediately preceding this application for a lifetime license, and that all statements and other information I have provided herein are true and correct to the best of my knowledge and belief.

Printed name of applicant or person completing application: ______Date: ______

Signature of applicant or person completing application: ______

SECTION 5: HARVEST INFORMATION PROGRAM (HIP) Lifetime Combination and Hunting Purchases Only Do you intend to hunt any migratory game birds (doves, ducks, geese, sandhill cranes, coot, snipe, rails, gallinules and woodcock) in Texas during the coming hunting season? Yes No If answer is yes, please complete the following questions. About how many of the following types of migratory game birds did you bag in Texas last season? Enter N for each type you did not hunt. Ducks: ______Geese: ______Doves: ______

Did you hunt any of these types of migratory birds in Texas last season? Coots/snipe: Yes No Rails/Gallinules: Yes No Woodcock: Yes No SECTION 6: GIFT (Complete if mailing to someone other than applicant) If this section is not complete, TPWD will contact the applicant directly for any information/documentation needed.

Name: ______Daytime Phone: ______

Address: ______City ______State ______Zip ______

CHECKLIST ADDITIONAL GIFT INFORMATION If purchasing for yourself, did you: If you are trying to surprise someone with a lifetime license and attach a copy of your valid Texas driver’s License or personal do not have the required documentation to submit, TPWD can identification card issued by the Texas Department of Public issue a gift certificate. Make sure all sections are complete and Safety (required of applicants 17 years of age and older)? a gift certificate valid for 90 days will be issued. If Section 6 is not complete, TPWD will contact the applicant listed in Section 3 attach your original current year hunting or fishing license, directly for any information needed. if applicable? (Copies are NOT accepted.) The gift certificate and notification of required documentation complete Section 4? needed to process the application will be mailed to the individual If a gift, did you: listed in Section 6. If required documentation is not received before the expiration date of the gift certificate, the lifetime complete Section 4 and Section 6? application will be withdrawn. PWD 0552 – A0900 (2/21) PAGE 2 OF 2