Hunting Fishing Application

I hereby authorize the Oklahoma Department of Veterans Affairs to obtain any and all information relevant to this application. This form will be submitted to: Oklahoma Dept. of Veterans Affairs Claims and Benefits Division 125 South Main, Room 1B38 Muskogee, OK 74401 * Denotes a required field

Date *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Claim/SSN *

Date of Birth *

Drivers License Number *

% of Disability

Disability

Service connected
Non-service connected

Check one box

RETURN TO BENEFITS