Maine



DISABLED VETERAN LICENSE APPLICATION _____ Hunt Firearm * (1814)_____ Hunt Archery ** 1814)_____ Fish (1814)See trapping application to apply for trapping Moses ID _____________Answer Questions: Did you fish tidal water last year: _____ Yes _____ No Do you intend to fish tidal this year: _____ Yes _____ NoName: _________________________________________________________________________DOB: _______________First LastMIGender: ______ Eyes: ______ Height: _______ Hair: ________ Weight: _______ Physical Address: _____________________________________________________________________________________ Street or Road City or Town State Zip CodeMailing Address: _____________________________________________________________________________________(If Different)Street/Road or Box # City or Town StateZip CodeDriver’s License Number: ___________________ Driver’s License State: _____________________________Email Address: _____________________________________________________Phone Number: _____________________Firearm Hunter Safety* – any person applying for a Firearm Hunting license must submit proof of successfully completing a firearm hunter safety course, or evidence of having held an adult firearm hunting license in any state, province or country in any year beginning with 1976. When proof of competency is not available, the applicant may sign an affidavit available through the town clerk or at Inland Fisheries and Wildlife Augusta Office or by visiting . Archery Hunter Safety** - any person applying for an archery hunting license must submit proof of successfully completing an archery hunter safety course or evidence of having held an archery hunting license in any state, province or country in any year beginning with 1980. When proof of competency is not available, the applicant may sign an affidavit available through the town clerk or at Inland Fisheries and Wildlife Augusta Office or by visiting Person Statement – all applicants for licenses that include hunting with a firearm must complete the Prohibited Person Statement on this form by signing that applicant is not a prohibited person. Benefits - if you would like to submit your application in person and inquire about other benefits that may be available to you, please visit the Maine Bureau of Veterans Services at 194 Winthrop Street Augusta, ME 04333 (Camp Keyes) or visit . 152400738505Prohibited Person StatementI am not a convicted felon, or have been convicted of Domestic Violence, as defined M.R.S.A. 15, Section 393By signing this document, I verify that it is true and accurate. I further understand that making any false statements may be punishable as a Class D crime pursuant to M.R.S.A. 17-A, Section 453.Applicant Signature: ________________________________________________________ Date: ______________________Signature00Prohibited Person StatementI am not a convicted felon, or have been convicted of Domestic Violence, as defined M.R.S.A. 15, Section 393By signing this document, I verify that it is true and accurate. I further understand that making any false statements may be punishable as a Class D crime pursuant to M.R.S.A. 17-A, Section 453.Applicant Signature: ________________________________________________________ Date: ______________________SignatureQualification - applicant must have a letter or documentation from the Veterans Administration specifically stating that the applicant is a veteran with service-connected disability evaluated at 50% or more. This license is available to residents of Maine, New Hampshire, Vermont, Rhode Island, Missouri, Texas, Delaware, and any other state that has reciprocal agreement with Maine. An applicant must provide a copy of a driver’s license or proof of residency. ................
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