Free 23742.FH11 - Indiana

APPLICATION FOR COMMERCIAL FISHING LICENSE ON OHIO RIVER
State Form 23742 (R3 / 2-04) Approved By State Board of Account, 2004

YEAR

INSTRUCTIONS: Please print or type information. BE SURE TO READ REGULATIONS. NOTE: This license is sold to residents of Indiana and Kentucky only. Do not use this form to apply for inland rivers or Lake Michigan commercial fishing license. Please attach check or money order and return to: Sugar Ridge Fish and Wildlife Area Fisheries Section 2310 E. State Road 364 Winslow, IN 47598-8735
Name of applicant Address (rural route or street) (city, state and ZIP code)

FOR OFFICE USE ONLY
License number Tag numbers Date issued

Telephone number County Old license number

Date of application Type of license (check one) New Renewed

NOTE: Each license costs $125.00 and includes 10 gear (net) tags. Additional tags are available only in groups of 10 Ohio River Commercial Fishing License including 10 tags

Plus

Number of additional packs of 10 tags at $15.00 each

Equals

Total

$125.00

+

X $15.00

What type(s) of fishing gear will you be using? Where will the fishing gear be used? (Give the city and county closest to where you fish.) Amount payable $ Check Money order Signature of applicant

=

$

Date