Free 35872.FH11 - Indiana

REQUEST FOR INDIANA SPORT HUNTING AND FISHING LICENSES
State Form 35872 (R4 / 7-03) Approved by State Board of Accounts, 2003

INSTRUCTIONS:

Mail to:

Allow ten (10) working days for processing.

Department of Natural Resources Customer Service Center 402 W. Washington St., Rm. W160 Indianapolis, IN 46204

Type of license requested Name of applicant Address (number and street or Rural Route) County Date of birth (month, day, year) * Social Security number ** Sex ZIP code Color of eyes Color of hair City Telephone number State

(
Height

)
Weight

Hunter education certification number *

State of certification Check number

Enclosed is my payment of $_______________________________.
Visa / MC number Signature of applicant Expiration date (month, year) Date signed (month, day, year)

* Hunters born after 12/31/86 must have Hunter Education Certification number. ** The request for your Social Security number is MANDATORY according to IC 14-22-11-3.