OKLAHOMA DEPARTMENT OF WILDLIFE CONSERVATION For Office Use Only

Street Address Mailing address Permit # ___________

1801 N. Lincoln P.O. Box 53465
Oklahoma City, OK 73105 Oklahoma City, OK 73152 Date Issued ___________
(405) 521-3851

SOCIAL SECURITY DISABILITY FISHING OR HUNTING LICENSE APPLICATION

Legal residents of Oklahoma who have resided in this state for at least six months and who are receiving
disability benefits through Social Security Disability, Supplemental Security Income (SSI), or Railroad
Retirement may purchase a disability fishing or hunting license for $10.00. Persons who are “permanently and
totally disabled” and receiving benefits through the Multiple Injury Trust Fund are also eligible for a disability
hunting or fishing license. Persons receiving disability benefits through the United States Postal Service are
eligible only for a disability fishing license. This license is valid for 5 years from the date of purchase. To
determine eligibility for this license, you must show proof of receiving disability benefits. Please see reverse
side of application for documentation requirements.

PAYMENT MUST BE MADE IN THE FORM OF A CASHIER’S CHECK OR MONEY ORDER.

____ Disability Fishing $10.00 ____ Disability Hunting $10.00

PLEASE PRINT OR TYPE:

NAME ____________________________________________________________________________________________
Last Name First Name Middle Initial

STREET ADDRESS ________________________________________________________________________________

CITY ___________________________________, Oklahoma ZIP CODE ____________ - _________

MAILING ADDRESS (if different) _________________________________________________________________________

HUNTER EDUCATION # ________________________ (Required if age 35 or under. Otherwise license will be issued with “apprentice”
designation. Not required for fishing.)

SOCIAL SECURITY NUMBER _________ - ______ - _________ DATE OF BIRTH _______/_______/_______

REQUIRED REQUIRED

DRIVER'S LICENSE NUMBER___________________________________ EXPIRATION DATE _______/_______

HOME PHONE NUMBER (_______) _______ - __________ DAY PHONE NUMBER (_______) _______ - __________

HEIGHT _____ ft _____ in WEIGHT ______ COLOR OF EYES ______ COLOR OF HAIR _______

I certify that I have been a bona fide resident of Oklahoma for the six months immediately preceding the date of this
application.

____________________________________________ _______/_______/_______
Signature of Applicant Date

________________________________________________
Signature of Authorized Department Employee
 DISABILITY LICENSE DOCUMENTATION REQUIREMENTS

Social Security Disability or Supplemental Security Income

The following documents must be included with your application:
1. Photocopy of your Notice of Award or a T.P.Q.Y. form, which you can obtain from a Social Security office.
The document submitted must be no more than six months old at the time of application for the disability
license. NOTE: If your award letter is more than six months old, you must provide a T.P.Q.Y. form or Benefit
Verification Statement that is no more than six months old.
The following documents will not be accepted: photocopy of your disability check; photocopy of your
Medicare card; your Form SSA 1099 – Social Security Benefit Statement; or your yearly letter from
Social Security stating “Your New Benefit Amount” at the top. These items do not state why you are
receiving benefits from Social Security.
2. Photocopy of your Oklahoma driver’s license or Oklahoma identification card. (See below for other
acceptable documentation to prove residency.)

Disability through Railroad Retirement

The following documents must be included with your application:
1. Photocopy of your Award Letter from the Railroad Retirement Board.
2. Photocopy of your Oklahoma driver’s license or Oklahoma identification card. (See below for other
acceptable documentation to prove residency.)

Disability through the United States Postal Service

The following documents must be included with your application:
1. Photocopy of your Approval Letter from the Office of Personnel Management at the United States Postal
Service.
2. Photocopy of your Oklahoma driver’s license or Oklahoma identification card. (See below for other
acceptable documentation to prove residency.)

Disability through the Multiple Injury Trust Fund

The following documents must be included with your application:
1. Photocopy of the file stamped copy of the court order from the Worker’s Compensation Court stating that
you are permanently and totally disabled.
2. Photocopy of your Oklahoma driver’s license or Oklahoma identification card. (See below for other
acceptable documentation to prove residency.)

Residency Verification
An Oklahoma driver’s license or Oklahoma identification card is required for proof of residency. Driver’s license
or identification card must have been issued at least six months prior to date of application, or it must state
“renewal” or “duplicate” in the upper left-hand corner.

Individuals who do not have a driver’s license or an identification card may submit six months of rent receipts
or utility bills. Receipt must be typed, dated, and state applicant’s name and address. (Handwritten receipts will
not be accepted.)

Lost or stolen licenses

Disability hunting and/or fishing licenses will be replaced for a fee of $1.50 per card. Contact the Department of
Wildlife Conservation for a replacement application.