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RHODE ISLAND DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 235 Promenade Street Providence RI 02908-5767 TDD 401-222-4462 Office of Boat Registration Licensing 3rd Floor Room 360 401 222-6647 Applicant ID Office use only Tin Office use only STATE OF RHODE ISLAND Non-Commercial Lobster Pot License Diver License Name Address City State Zip Code Date of Birth Sex M/F RI Driver s License Number Hair Color Weight Eye Color Height Occupation If additional information is needed please provide us with one of the following Phone number or Email address Lobster Non-Commercial Pot RI GL 20-7-3 License 40. 00 Buoy colors // Pot Number You can choose up to three colors Office use only Under penalty of law I certify that the foregoing statements are true and that I am a resident of the State of Rhode Island. Resident means an individual who has had his or her actual place of residence and has lived in the State Applicant s Signature Date Notary Public New Applicants only Commission Expires Notes Checks/Money Orders payable to State of RI DEM mail or deliver to the address above. RHODE ISLAND DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 235 Promenade Street Providence RI 02908-5767 TDD 401-222-4462 Office of Boat Registration Licensing 3rd Floor Room 360 401 222-6647 Applicant ID Office use only Tin Office use only STATE OF RHODE ISLAND Non-Commercial Lobster Pot License Diver License Name Address City State Zip Code Date of Birth Sex M/F RI Driver s License Number Hair Color Weight Eye Color Height Occupation If additional information is needed please provide us with one of the following Phone number or Email address Lobster Non-Commercial Pot RI GL 20-7-3 License 40. 00 Buoy colors // Pot Number You can choose up to three colors Office use only Under penalty of law I certify that the foregoing statements are true and that I am a resident of the State of Rhode Island. Resident means an individual who has had his or her actual place of residence and has lived in the State Applicant s Signature Date Notary Public New Applicants only Commission Expires Notes Checks/Money Orders payable to State of RI DEM mail or deliver to the address above. RHODE ISLAND DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 235 Promenade Street Providence RI 02908-5767 TDD 401-222-4462 Office of Boat Registration Licensing 3rd Floor Room 360 401 222-6647 Applicant ID Office use only Tin Office use only STATE OF RHODE ISLAND Non-Commercial Lobster Pot License Diver License Name Address City State Zip Code Date of Birth Sex M/F RI Driver s License Number Hair Color Weight Eye Color Height Occupation If additional information is needed please provide us with one of the following Phone number or Email address Lobster Non-Commercial Pot RI GL 20-7-3 License 40. 00 Buoy colors // Pot Number You can choose up to three colors Office use only Under penalty of law I certify that the foregoing statements are true and that I am a resident of the State of Rhode Island. 00 Buoy colors // Pot Number You can choose up to three colors Office use only Under penalty of law I certify that the foregoing statements are true and that I am a resident of the State of Rhode Island. Resident means an individual who has had his or her actual place of residence and has lived in the State Applicant s Signature Date Notary Public New Applicants only Commission Expires Notes Checks/Money Orders payable to State of RI DEM mail or deliver to the address above.

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