Alaska Department of Fish and Game - Trophy Fish Affidavit
(Please type or print clearly)

I am applying for the following certificate:     
(check only one)     
__________ Honorary Catch & Release
__________ Trophy Certificate

Species: _______________________       Certified Weight: ____lb. ___oz. (Does not apply to Catch & Release)

Length: ______________________inches         Caught in:  ____ Marine OR ____ Freshwater?

Date caught: _______________________         Location Caught: ______________________

Sport Fish license #: _________________         Age (if entrant under 16 years old): ________

Entrant's name (please print) ____________________________________________________

Mailing Address _____________________________________________________________

City/State ______________________________________    Zip Code __________________
The undersigned Trophy Official does hereby verify the identity of the described fish:

Official's name (please print) ____________________________  Scales certification date: ______

Official's mailing address _________________________________________________________

We the undersigned witnessed the weighing and measuring of the fish described above, and verify the weight and measurements recorded:

Witness 1. (signature/address) _______________________________________________

Witness 2. (signature/address) _______________________________________________

I hereby swear that in taking this fish I complied with all the rules and regulations in the location the fish was caught, and that the witnesses actually witnessed the weighing and measuring of this fish. I further declare that all the above information is true and correct.

Entrant's signature _____________________________________________________

Official's signature _____________________________________________________

Certified by me this (date) _______________________________________________
Mail this original affidavit and the photograph to:
ADFG Sport Fish Division
PO Box 25526
Juneau, AK 99802-5526

The Alaska Department of Fish and Game administers all programs and activities free from discrimination based on race, color, national origin, age, sex, religion, marital status, pregnancy, parenthood, or disability. The department administers all programs and activities in compliance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, the Age Discrimination Act of 1975, and Title IX of the Education Amendments of 1972.

If you believe you have been discriminated against in any program, activity, or facility, or if you desire further information please write to ADF&G, P.O. Box 25526, Juneau, AK 99802-5526; U.S. Fish and Wildlife Service, 4040 N. Fairfax Drive, Suite 300 Webb, Arlington, VA 22203; or O.E.O., U.S. Department of the Interior, Washington DC 20240.

For information on alternative formats for this and other department publications, please contact the department ADA Coordinator at (voice) 907-465-4120, (TDD) 907-465-3646, or (FAX) 907-465-2440.