Lake License by EchoMovement

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									                                             CLASS “A” LAKE LICENSE APPLICATION




NEW MEXICO DEPARTMENT OF GAME & FISH                                            License Year (April 1 - March 31)
LAW ENFORCEMENT DIVISION                                                        License Fee $101.00/License Year
SPECIAL USE PERMITS PROGRAM                                                     Additional Lake License Fee $26.00 per each
P.O. BOX 25112                                                                    additional lake per License Year
SANTA FE, NEW MEXICO 87504
(505)476-8064

Please submit this application and the appropriate fee to the address listed above. AMOUNT ENCLOSED______________

NAME OF APPLICANT             ______________________________________________________ DATE ______________________
MAILING ADDRESS               ______________________________________________________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            Acre Feet of            Source of Water           *Water Filing Number
                                                        Depth               Water                                                   Date
                                                                          Impounded




*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

                                               Signature                                  Approved                      Disapproved
Conservation Officer                    ________________________                          ________                      __________
Area Fish Manager                       ________________________                          ________                      __________
Area Supervisor                         ________________________                          ________                      __________
Chief, Fisheries Division               ________________________                          ________                      __________

								
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