The Alaska 11 525 form is a vital application used for obtaining a Commercial Fishing Crewmember License in Alaska. This license is essential for individuals wishing to participate in commercial fishing activities within the state. It is important to ensure all information is accurately completed to avoid any issues with licensing.
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The Alaska 11 525 form is essential for individuals seeking a Commercial Fishing Crewmember License in the state of Alaska. This application includes critical information such as the applicant's residency status, personal identification details, and compliance with child support orders. Applicants must indicate their license type, which varies based on residency and age, and include payment information for the applicable fees. The form also requires the applicant's social security number or alien registration number, in accordance with state law. Additionally, the application emphasizes the importance of truthfulness, as providing false information can result in significant penalties. The Department of Fish and Game will verify each application against the Child Support Services Division's records to ensure compliance. Understanding the requirements and implications of this form is crucial for those intending to engage in commercial fishing activities in Alaska.
Department of Fish and Game
Division of Administrative Services
Licensing Section
P.O. Box 115525
Juneau, Alaska 99811-5525
Phone: (907) 465-2376; Fax: (907) 465-2440
e-mail: dfg.das.licensehelp@alaska.gov
COMMERCIAL FISHING CREWMEMBER LICENSE APPLICATION
License Number Issued:_____________________
If you are not in substantial compliance with your child support order and are on Alaska's Child Support Services Division's (CSSD) outstanding report, your license is null and void at the time of purchase. You will be subject to criminal sanctions for participation in any commercial crewmember activities. The Department of Fish and Game will match each licensee against CSSD's report. Notice will be served that the license is void and invalid.
CHECK ONLY ONE: (License Type / Class)
CHECK AND COMPLETE THE FOLLOWING AS
Resident
/ Class 30
$60.00
Nonresident / Class 31
$200.00
THEY APPLY TO APPLICANT:
Resident Child / Class 34 (10 or less years old) $5.00
Nonresident Child / Class 35
$145.00
Alaska Resident
Residency: Actual number
Resident 7 day / Class 36 $30.00
Nonresident 7 day /Class 37
$30.00
of years and months as a
*Duplicate / Class 32
$5.00
Nonresident
resident is required. If non-
For class 36, and 37
AM
resident, write "none."
Years
Months
STARTING DATE
M M / D D / Y Y Y Y
STARTING HOUR
PM
U.S. Citizen
This certiies that application is being made in accordance with applicable laws.
License Year
Alien
Name (irst)
(middle)
(last)
Alien Reg. No.
Mailing Address
Physical Location of Residence (If same as Mailing address, write "Same."
City, State,
Zip Code
Country
City, State, Zip Code
Social Security Number (required)
Weight (lbs)
Eye Color Hair Color
Height (FT/IN)
Sex
Drivers License No.
M F
Birth Date
mm/dd/yy
Telephone Number
(Optional)
Fax Number
Your E-mail Address:
Social Security Number Advisory: You are required to provide your social security number, if over 16 years of age, when applying for a Commercial Crewmember license unless you have an alien registration number. This information is required per AS 25.27.244.
ALASKA RESIDENT AS 16.05.415 & AS 16.05.940: “resident” means, 1) a person (including an alien) who is physically present in Alaska with the intent to remain indeinitely and make a home here, has maintained that person’s domicile in Alaska for the 12 consecutive months immediately preceding this application for a license, and is not claiming residency or obtaining beneits under a claim of residency in another state, territory or country; 2) a member of the military service or U.S. Coast Guard who has been stationed in Alaska for the 12 consecutive months immediately preceding this application for a license; or 3) a dependent of a resident member of the military service or U.S. Coast Guard who has lived in Alaska for the 12 months immediately preced- ing this application for a license. A person who does not otherwise qualify as a resident may not qualify by virtue of an interest in an Alaska business. A person who establishes residency as outlined above remains a resident during an absence for from the state unless during the absence the person (1) establishes or claims residency in another state, territory, or country; or (2) performs an act, or is absent under circumstances, that are inconsistent with the intent to remain indeinitely and make a home in Alaska. A person who establishes residency as outlined above remains a resident during an absence from the state unless during the absence the person (1) establishes or claims residency in another state, territory or country; or (2) performs an act or is absent under circumstances that are inconsistent with the intent to remain indeinitely and make a home in Alaska.
AS 16.05.480(a) A person engaged in commercial ishing is required to hold a limited entry permit, an interim-use permit or a cremember ishing license. If a person already holds a limited entry or interim-use permit for the year, a crewmember license is not needed.
Payment Information (Make checks payable to State of Alaska)
Check or Money Order
Visa
MasterCard
Card No.
Expire
Signature _________________________________________________
AFFIDAVIT FOR DUPLICATE COMMERCIAL FISHING CREWMEMBER LICENSE
I hereby report the loss of my current Commercial Fishing Crewmember License issued to me in accordance with the Fish and Game Code of Alaska as follows:
Number of License, If Known
Issued By (Name of License Oficer)
Date of Issuance
Place of Issuance
I have personally reviewed the information on this application and I hereby certify that all the information on this applica- tion is true and correct and that I understand this information except social security number is subject to public disclosure. NOTE: Providing false information is subject to a maximum ine of $10,000 or one year imprisonment or both, per AS
11.56.210 and AS 16.05.665.
Applicant X
Date:
11-525(rev 04/12)
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