Application for Lifetime SEND PHOTOCOPIES

Sportsman’s License NO FORMS WILL BE

RETURNED
PLEASE TYPE OR PRINT LEGIBLY
Mail application & attachments to: LBRU–Lifetime, 2065 US Hwy. 278, SE, Social Circle, GA 30025
*Please see the reverse side (or 2nd page) for instructions and detailed documentation requirements.
Official USPS postmark date on mailed envelope is used for age eligibility – request local post office mark.
LAST FIRST MI DRIVER’S LICENSE # (See Document Req.)* DL STATE

___ ___ ___ ___ ___ ___ ___ ___ ___

MAILING ADDRESS CITY STATE ZIP
___ ___ ___ ___ ___
PHYSICAL ADDRESS  Same as Mailing Address CITY STATE ZIP
___ ___ ___ ___ ___
SSN DATE OF BIRTH GENDER PROOF OF RESIDENCY PROVIDED (See Document Req.)*

___ ___ ___- ___ ___ - ___ ___ ___ ___ M___ ___ D ___ ___Y ___ ___ ___ ___
 Male  Female  GA Driver’s License  State of GA ID Card
EMAIL ADDRESS (Optional, will be used to send a pdf of the issued license) PHONE TEXT NUMBER (optional)
(___ ___ ___) ___ ___ ___ - ___ ___ ___ ____ (___ ___ ___) ___ ___ ___ - ___ ___ ___ ___
HUNTER EDUCATION # (Requirements listed on back for each license type)* HUNTER ED STATE COUNTY OF RESIDENCE

Lifetime Licenses restricted to: 1. residents of GA; 2. Nonresidents under 2 years of age; 3. Nonresident grandchildren from 2 years to
less than 16 years of age of current RESIDENT Paid Lifetime License holders (does not include free Senior Lifetime License holders).
SELECT LIFETIME LICENSE DESIRED (*Supporting Document Requirements Listed on Back)
MARK ONE License Type ** Cost shown includes transaction fee Cost** Req’d Fee
[ ] Infant (Under 2 Years of Age, Resident or Nonresident) $503
[ ] Youth (2 thru 15 years, Resident) $603
[ ] Adult (16 thru 49 years, Resident) $753
[ ] Adult (50 thru 59 years, Resident) $378
[ ] Senior Discount (60+, Resident) $318
[ ] Veterans (Honorably Discharged, Resident) $603
[ ] Military (Active Duty, Resident) $603
[ ] Senior 65+ Sportsman’s (Born On or After July 1, 1952, Resident) $73
[ ] Senior 65+ Fishing Only (Born On or After July 1, 1952, Resident) $38
[ ] Senior 65+ Hunting Only (Born On or After July 1, 1952, Resident) $38
[ ] Senior 65+ Sportsman’s (Born BEFORE July 1, 1952, Resident) - No Card $0, Available Online/Agents
[ ] Nonresident Grandchild (2 Years to Less Than 16 Years Old) $1,503
One plastic lifetime card is included with your purchase of any of the paid licenses (cost > $0) above.
Extra / Replacement Plastic Lifetime Card(s) (Fee = Qty X $13) Qty ___ $13 ea
Grand Total (add the Req’d fee + any extra cards) $________
If this application is for a Nonresident Youth Grandchild (2 years to <16 years of age) complete the following:

Name of Grandparent with Paid Lifetime License: _____________________________________________

Lifetime License Number: ________________DOB: ___/____/______ Tel. No: (____)______/__________

O.C.G.A 16-10-20; “A person who knowingly and willfully makes a false, fictitious or fraudulent statement…in any manner within the jurisdiction
of any department or agency of state government…shall, upon conviction thereof, be punished by a fine of not more than $1000 or by
imprisonment for not less than five years, or both.” Applicant Hunter Education Attestation: * If I was born on or after January 1, 1961, I
attest that I will obtain hunter education before using this license for hunting. If for infant or youth, I will make them aware that any person less
than 16 years of age must hunt under adult supervision, except for those 12 to 15 years of age may obtain hunter education to hunt without
adult supervision. If paying by credit card, I agree to the charges shown, and acknowledge fees shown are non-refundable.

______________________ _________________________________________________________________
Date Signature of Applicant / Parent / Grandparent
 Check # ______________________; or
 If paying by Credit card, enter card # here:______________________________________
Type of card: Visa MasterCard Discover Expiration Date:____/____/_______ Security Code #______
Billing Address Zip Code (if different from Mailing Address Zip Code Above) __________ DNR Use:  Cash
Allow up to 5 days for processing. Licenses will only be mailed to the Applicants mailing address (No Exceptions). A copy of
this application can be used to hunt or fish, provided you attach a copy of the check/money order used as payment, unless paid by
credit card, and you meet the age requirement for the license for which you have applied. Rev 6-19-19
 LIFETIME SPORTSMAN’S LICENSE
GA Code Reference:
This application has been developed in accordance with Ga. Code 27-2-3.1, which establishes the regulations
governing the acquisition and possession of Lifetime Sportsman’s Licenses.
Definitions:
1. Resident: For purposes of this license, “resident” is defined as continuous domicile within GA for a minimum
of 3 consecutive months immediately prior to procuring license. Persons may only be a resident of one state.
2. Birth Certificate: For infant, youth, and non-resident grandchild licenses, the required birth certificate is a
photocopy of either an original or certified copy of a U.S. Birth Certificate / Amended Birth Certificate filed
with the State Office of Vital Statistics or equivalent agency in the Applicant's state of birth including U.S.
Territories and the District of Columbia; hospital issued birth certificates or hospital notices or announcements
of birth not accepted.
3. Hunter Education: completion of a hunter education course certified or mandated by any state or Canadian
providence. Hunter Education not required to purchase a lifetime license, but must be obtained before using it
for hunting if born on or after January 1, 1961. Attestation must be signed on the front side of this application.
Supporting Document Requirements:
Applications must be accompanied by the following (NO EXCEPTIONS). Send Copies Only, documents will not
be returned. USPS postmark date on mailed envelope is used for age eligibility. Request local post office postmark; otherwise
USPS distribution center postmark may be the only postmark applied many days after mailing.
Infant: (Resident or Nonresident, Under 2 Years of Age)
1. Photocopy of Child’s Birth Certificate (see above for description of required birth certificate).
Resident Youth: (2 thru 15 years of Age)
1. Photocopy of Child’s Birth Certificate (see above for description of required birth certificate), AND
2. Copy of Parent’s Picture ID: Current GA Driver’s License or Georgia ID Card issued by Department of
Driver Services for parent on the Birth Certificate (not including a GA Driver’s License or Georgia ID Card
issued pursuant to O.C.G.A. §40-5-21.1 - temporary license), or court order plus Picture ID showing parental
rights if parent not listed on birth certificate, AND
3. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired.
Resident Adult: (For age 16 & 17, requires #1 & #2 from Resident Youth if ID issued less than 3 months previous)
1. Copy of Picture ID (choose one): Current GA Driver’s License or Georgia ID Card issued by Department of
Driver Services (not including a GA Driver’s License or Georgia ID Card issued pursuant to O.C.G.A. §40-
5-21.1 - temporary license) AND
2. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired..
Resident Senior 65+ /Senior Discount 60+ :
1. Copy of Picture ID (choose one): Current GA Driver’s License or GA ID Card issued by Dept. of Driver
Services (not including a GA Driver’s License or GA ID Card issued pursuant to O.C.G.A. §40-5-21.1,
temporary license). Free if born BEFORE July 1, 1952. Senior 65+ can also be obtained online & from agents.
Resident Veterans: (Honorably Discharged) Note: Resident Veterans age 50 up consider Adult License 50-59 yrs.
1. Copy of Picture ID (choose one): Current GA Driver’s License or Georgia ID Card issued by Department of
Driver Services (not including a GA Driver’s License or Georgia ID Card issued pursuant to O.C.G.A. §40-
5-21.1 - temporary license) AND
2. Copy of DD 214: providing satisfactory evidence that applicant served more than 90 days of federal active
duty military service and was honorably discharged AND
3. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired.
Resident Military: (Active Duty) Note: Resident Military age 50 up should consider Adult License 50-59 yrs.
1. Copy of Picture ID (choose one): Current GA Driver’s License or Georgia ID Card issued by Department of
Driver Services (not including a GA Driver’s License or Georgia ID Card issued pursuant to O.C.G.A. §40-
5-21.1 - temporary license) AND
2. Copy of Valid U.S. Department of Defense Common Access card with a Uniformed Services Affiliation, AND
3. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired.
Non-Resident Grandchild (2 years to less than 16 years of age):
1. Photocopy of Child’s Birth Certificate (see above for description of required birth certificate) AND
2. Non-Resident Grandchild: Notarized Certification of relationship of Lifetime License holder & Grandchild AND
3. Copy of Grandparent’s Picture ID (choose one): Current GA Driver’s License or Georgia ID Card issued by
Department of Driver Services (not including a GA Driver’s License or Georgia ID Card issued pursuant to
O.C.G.A. §40-5-21.1 - temporary license), AND
4. Copy of Hunter Education Card: if obtained. Include State where Hunter Ed was acquired, AND
5. Provide required information for grandparent’s paid lifetime license on page 1 of this application. The free
Senior Lifetime License is not eligible.
Allow up to 5 days for processing. Licenses will only be mailed to the Applicants mailing address (No Exceptions). A copy of
this application can be used to hunt or fish, provided you attach a copy of the check/money order used as payment, unless paid by
credit card, and you meet the age requirement for the license for which you have applied. Rev 6-19-19