CLASS “A” LAKE LICENSE APPLICATION
NEW MEXICO DEPARTMENT OF GAME & FISH LAW ENFORCEMENT DIVISION SPECIAL USE PERMITS PROGRAM P.O. BOX 25112 SANTA FE, NEW MEXICO 87504 (505)476-8064
License Year (April 1 - March 31) License Fee $101.00/License Year Additional Lake License Fee $26.00 per each additional lake per License Year
Please submit this application and the appropriate fee to the address listed above. AMOUNT ENCLOSED______________ NAME OF APPLICANT MAILING ADDRESS ______________________________________________________ DATE ______________________ ______________________________________________________TELEPHONE NO: _____________
CITY ____________________________________ STATE _____________________________ ZIP CODE ___________________ LOCATION OF POND OR PONDS (nearest town or settlement) ___________________________________________________ (COUNTY) _____________________(SECTION) _______________ (TOWNSHIP) _____________ (RANGE) _____________ If more than one pond or lake is listed below, indicate whether they are: All on one property ________________ or, on separate properties _____________. If more than one property is involved, are the properties separated by land not owned or leased by the applicant? ____________________________________________________________________________________________ Name of Lake or Pond Size (area) Maximum Depth Acre Feet of Water Impounded Source of Water *Water Filing Number Date
*If water filing is not recorded with State Engineer, applicant certifies that he/she is aware of the provisions of Section 17-4-11 NMSA 1978 Compilation (attached). if any of the above ponds or lakes is fed from public stream or empties into public stream, how are ingress and egress of fish prevented?___________________________________________________________________________________________ Number, kind and size of fish on hand _______________________________________________________________________ Number, kind and size of fish to be purchased _________________________________________________________________ Where purchased (name and address) _______________________________________________________________________ _______________________________________________________________________ How to be disposed of (marketed or by selling fishing privileges) _________________________________________________ ________________________________________________________________________________________________________ All lake licenses are valid for one license year and are renewable. A series of lakes in close proximity to each other may be considered under one license. If the lakes to be licensed are on properties separated by land not owned or leased by the applicant, they must be covered by a $26.00 additional lake license. I HEREBY CERTIFY THAT THE FOREGOING STATEMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT I HAVE CAREFULLY REVIEWED THE ATTACHED STATUTES PERTAINING TO CLASS “A” LAKES WHICH I WILL KEEP FOR FUTURE REFERENCE. ______________________________ Date ______________________________________________________ Signature of Applicant
Conservation Officer Area Fish Manager Area Supervisor Chief, Fisheries Division
Signature ________________________ ________________________ ________________________ ________________________
Approved ________ ________ ________ ________
Disapproved __________ __________ __________ __________