W. Va. Code R. agency 58, tit. 58, ser. 58-17, app B
NONRESIDENT STATEWIDE FUR DEALER'S APPLICATION FORM
WEST VIRGINIA DIVISION OF NATURAL RESOURCES
APPLICATION FOR A NONRESIDENT STATEWIDE FUR DEALER'S LICENSE
(West Virginia Code '20-2-49)
INITIAL APPLICATION (___) RENEWAL APPLICATION (___)
NAME: __________________________________________________
STREET or BOX: __________________________________________
CITY and COUNTY: ________________________________________
STATE and ZIP CODE: _____________________________________
TELEPHONE NUMBER: ____________________________________
CURRENT WEST VIRGINIA DNR
FUR DEALER'S LICENSE NUMBER: __________________________
I agree to abide by the terms and conditions of my license.
_______________________________ _____________
(Signature of Applicant) Date
Annual Fee for Nonresident Statewide License: $50.00 RETURN TO:WV Division of Natural Resources
Law Enforcement Section
Room 837, Building 3
State Capitol Complex
Charleston, WV 25305
THE FOLLOWING AGENTS ARE EMPLOYED BY THE APPLICANT:
___________________________________________________________
(Name of Agent) (Street or Box)
______________________________________________________________
(City) (County) (State) (Zip Code)
I agree to abide by the terms and conditions of my permit.
_________________________ _____________
(Signature of Agent) (Date)
-------------------------------------------------------------------------------------------------------------------
_________________________________________________________
(Name of Agent) (Street or Box)
_______________________________________________________________
(City) (County) (State) (Zip Code)
I agree to abide by the terms and conditions of my permit.
_________________________ _____________
(Signature of Agent) (Date)
-------------------------------------------------------------------------------------------------------------------
____________________________________________________________
(Name of Agent) (Street or Box)
_____________________________________________________________
(City) (County) (State) (Zip Code)
I agree to abide by the terms and conditions of my permit.
_________________________ _____________
(Signature of Agent) (Date)
___________________________________________________________
(Name of Agent) (Street or Box)
______________________________________________________________
(City) (County) (State) (Zip Code)
I agree to abide by the terms and conditions of my permit.
_________________________ _____________
(Signature of Agent) (Date)
W. Va. Code R. agency 58, tit. 58, ser. 58-17, app B