8/8/2019 Disability Hunting.fishing License App

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O K L A H O M A D E P A R T M E N T O F W I L D L I F E C O N S ER VAT I O N

Street Address Mailing address 1801 N. Lincoln P.O. Box 53465Oklahoma City, OK 73105 Oklahoma City, OK 73152(405) 521-3851

SOCIAL SECURITY DISABILITY FISHING OR HUNTING LICENSE APPLICATION

Legal residents of Oklahoma who have resided in this state for at least six months and who are receivingdisability benefits through Social Security Disability, Supplemental Security Income (SSI), or RailroadRetirement may purchase a disability fishing or hunting license for $10.00. Persons who are permanently andtotally disabled and receiving benefits through the Multiple Injury Trust Fund are also eligible for a disabilityhunting or fishing license. Persons receiving disability benefits through the United States Postal Service areeligible only for a disability fishing license. This license is valid for 5 years from the date of purchase. Todetermine eligibility for this license, you must show proof of receiving disability benefits. Please see reverseside of application for documentation requirements.

PAYMENT MUST BE MADE IN THE FORM OF A CASHIERS CHECK OR MONEY ORDER.

____ Disability Fishing $10.00 ____ Disability Hunting $10.00

PLEASE PRINT OR TYPE:

NAME ____________________________________________________________________________________________ Last Name First Name Middle Initial

STREET ADDRESS ________________________________________________________________________________

CITY ___________________________________, Oklahoma ZIP CODE ____________ - _________

MAILING ADDRESS (if different) _________________________________________________________________________

HUNTER EDUCATION # ________________________ (Required if age 35 or under. Otherwise license will be issued with apprenticedesignation. Not required for fishing.)

SOCIAL SECURITY NUMBER _________ - ______ - _________ DATE OF BIRTH _______/_______/_______ REQUIRED REQUIRED

DRIVER'S LICENSE NUMBER___________________________________ EXPIRATION DATE _______/_______

HOME PHONE NUMBER (_______) _______ - __________ DAY PHONE NUMBER (_______) _______ - __________

HEIGHT _____ ft _____ in WEIGHT ______ COLOR OF EYES ______ COLOR OF HAIR _______

I certify that I have been a bona fide resident of Oklahoma for the six months immediately preceding the date of thisapplication.

____________________________________________ _______/_______/_______ Signature of Applicant Date

________________________________________________ Signature of Authorized Department Employee

For Office Use Only

Permit # ___________

Date Issued ___________

8/8/2019 Disability Hunting.fishing License App

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DISABILITY LICENSE DOCUMENTATION REQUIREMENTS

Social Security Disability or Supplemental Security IncomeThe following documents must be included with your application:1. Photocopy of your Notice of Award or a T.P.Q.Y. form, which you can obtain from a Social Security office.The document submitted must be no more than six months old at the time of application for the disabilitylicense. NOTE: If your award letter is more than six months old, you must provide a T.P.Q.Y. form or Benefit Verification Statement that is no more than six months old. The following documents will not be accepted: photocopy of your disability check; photocopy of yourMedicare card; your Form SSA 1099 Social Security Benefit Statement; or your yearly letter fromSocial Security stating Your New Benefit Amount at the top. These items do not state why you arereceiving benefits from Social Security.2. Photocopy of your Oklahoma drivers license or Oklahoma identification card. (See below for otheracceptable documentation to prove residency.)

Disability through Railroad RetirementThe following documents must be included with your application:1. Photocopy of your Award Letter from the Railroad Retirement Board.2. Photocopy of your Oklahoma drivers license or Oklahoma identification card. (See below for otheracceptable documentation to prove residency.)

Disability through the United States Postal ServiceThe following documents must be included with your application:1. Photocopy of your Approval Letter from the Office of Personnel Management at the United States PostalService.2. Photocopy of your Oklahoma drivers license or Oklahoma identification card. (See below for otheracceptable documentation to prove residency.)

Disability through the Multiple Injury Trust FundThe following documents must be included with your application:1. Photocopy of the file stamped copy of the court order from the Workers Compensation Court stating thatyou are permanently and totally disabled.2. Photocopy of your Oklahoma drivers license or Oklahoma identification card. (See below for otheracceptable documentation to prove residency.)

Residency VerificationAn Oklahoma drivers license or Oklahoma identification card is required for proof of residency. Drivers licenseor identification card must have been issued at least six months prior to date of application, or it must state

renewal or duplicate in the upper left-hand corner.

Individuals who do not have a drivers license or an identification card may submit six months of rent receiptsor utility bills. Receipt must be typed, dated, and state applicants name and address. (Handwritten receipts willnot be accepted.)

Lost or stolen licensesDisability hunting and/or fishing licenses will be replaced for a fee of $1.50 per card. Contact the Department ofWildlife Conservation for a replacement application.