Get Disabled Fishing License Alabama

Print Form Application for Alabama Resident Disabled Fishing License Take application to your physician. A physician must fill out the physicians statement and sign. Return the complete application to the Probate Judge Revenue Department or License Commissioner in your county of residence. PRINT OR TYPE ONLY Social Security Number -- Name first middle last Residence Address City State Zip Code Mailing Address if different County of Residence Length of residence Date of Birth // Age Drivers License Nbr Color Hair Color Eyes Height Weight lbs. Signature Date // ----------------------------------------PHYSICIANS ONLY----------------------------------Physician Statement s excerpt of SECTION 9-11-54 CODE OF ALABAMA 1975 For the purpose of this license the term disabled means inability to engage in any substantial gainful activity by reason of any medically determinable physical impairment which can be expected to result in death or in blindness or to be long continued and indefinite duration* The term blindness as used in this section means central visual acuity of 5/200 or less in the better eye with the use of a corrective lens. An eye in which the visual field is reduced to five degrees or less concentric contraction shall be considered for the purposes of this section as having a central visual acuity of 5/200 or less. Type of Disability If Blindness Visual Acuity Duration of Disability This is to certify that the applicant named above is totally disabled as defined by Section 9-11-54 Code of Alabama 1975. PRINT OR TYPE ONLY Social Security Number -- Name first middle last Residence Address City State Zip Code Mailing Address if different County of Residence Length of residence Date of Birth // Age Drivers License Nbr Color Hair Color Eyes Height Weight lbs. Signature Date // ----------------------------------------PHYSICIANS ONLY----------------------------------Physician Statement s excerpt of SECTION 9-11-54 CODE OF ALABAMA 1975 For the purpose of this license the term disabled means inability to engage in any substantial gainful activity by reason of any medically determinable physical impairment which can be expected to result in death or in blindness or to be long continued and indefinite duration* The term blindness as used in this section means central visual acuity of 5/200 or less in the better eye with the use of a corrective lens. Signature Date // ----------------------------------------PHYSICIANS ONLY----------------------------------Physician Statement s excerpt of SECTION 9-11-54 CODE OF ALABAMA 1975 For the purpose of this license the term disabled means inability to engage in any substantial gainful activity by reason of any medically determinable physical impairment which can be expected to result in death or in blindness or to be long continued and indefinite duration* The term blindness as used in this section means central visual acuity of 5/200 or less in the better eye with the use of a corrective lens. An eye in which the visual field is reduced to five degrees or less concentric contraction shall be considered for the purposes of this section as having a central visual acuity of 5/200 or less.