Get Arizona White Amur Stocking And Holdinbg License Application

Arizona Game and Fish Department PLEASE PRINT OR TYPE APPLICATION FOR RESTOCKING WHITE AMUR FEE None Current White Amur Stocking and Holding License No. Name Date of Birth Address Phone City State Zip Department ID Number/SSN Social Security Number is voluntary-to be used for Sportsman s Database Only Gender Height Eyes Hair Email Address If for commercial purposes Business Name If holding at a business location Title of Applicant s Position Purpose of restocking Circle appropriate reason A. Control aquatic weeds that interfere with the use of the water R12-4-424 G*3. a B. C. For sale from a licensed fish farm R12-4-424 G*3. c Amur number Amur size Restocking Dates Supplier 1 Name Attachments Addition information required under R12-4-424 Detailed diagram of the aquatic stocking system* Description of how the system meets the definition of a closed aquatic system* see section A. 1 APPLICANT SIGNATURE I certify the above is true and correct and that my live wildlife privileges are not revoked in this or any other state or the United States. Approved By Date Form 2724-B Revised 11/06 FOR DEPARTMENT USE ONLY Date Received Date Reviewer Received Valid From Region Denied To Print Form. Control aquatic weeds that interfere with the use of the water R12-4-424 G*3. a B. C. For sale from a licensed fish farm R12-4-424 G*3. c Amur number Amur size Restocking Dates Supplier 1 Name Attachments Addition information required under R12-4-424 Detailed diagram of the aquatic stocking system* Description of how the system meets the definition of a closed aquatic system* see section A. c Amur number Amur size Restocking Dates Supplier 1 Name Attachments Addition information required under R12-4-424 Detailed diagram of the aquatic stocking system* Description of how the system meets the definition of a closed aquatic system* see section A. 1 APPLICANT SIGNATURE I certify the above is true and correct and that my live wildlife privileges are not revoked in this or any other state or the United States. 1 APPLICANT SIGNATURE I certify the above is true and correct and that my live wildlife privileges are not revoked in this or any other state or the United States. Approved By Date Form 2724-B Revised 11/06 FOR DEPARTMENT USE ONLY Date Received Date Reviewer Received Valid From Region Denied To Print Form. Control aquatic weeds that interfere with the use of the water R12-4-424 G*3. a B. C. For sale from a licensed fish farm R12-4-424 G*3. c Amur number Amur size Restocking Dates Supplier 1 Name Attachments Addition information required under R12-4-424 Detailed diagram of the aquatic stocking system* Description of how the system meets the definition of a closed aquatic system* see section A. 1 APPLICANT SIGNATURE I certify the above is true and correct and that my live wildlife privileges are not revoked in this or any other state or the United States. c Amur number Amur size Restocking Dates Supplier 1 Name Attachments Addition information required under R12-4-424 Detailed diagram of the aquatic stocking system* Description of how the system meets the definition of a closed aquatic system* see section A. 1 APPLICANT SIGNATURE I certify the above is true and correct and that my live wildlife privileges are not revoked in this or any other state or the United States. Approved By Date Form 2724-B Revised 11/06 FOR DEPARTMENT USE ONLY Date Received Date Reviewer Received Valid From Region Denied To Print Form.