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2. First Name*
3. Last Name*
5. Physical Address*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Email Address*
14. Mailing Address
    (only needed if different from physical address)
16. City
17. State
18. Zip
20. Date of Birth*
    DD/MM/YYYY
22. Height*
23. Weight*
25. Hair Color*
    -- Select One --BaldBlackBlondBrownGreyRed
26. Eye Color*
    -- Select One --BlueBrownGreenHazel
28. Drivers License Number*
29. State of DL*
    2 letter state code
31. Note:

    This is an application only please remit payment for permit to the Sheriff's office.

33. Hunter Education Info
    Hunters are required to have either a Utah Hunters Education Certificate of Completion ("Blue Card"), have a birth date of Dec 31, 1965 or earlier, or a current Utah (Small Game) license in order to purchase a spotlighting permit.
35. Date of Birth before Dec 31, 1965?*

    1. Yes
    2. No
37. Also apply for a child under the age of 16?

    1. Yes
    2. No
39. Payment Options
    Pay Online Here (this will open in a new window)

    If you pay online, you must return to this page and submit your application. Once your payment is received you will receive your permit number by email. If you pay online with a credit card you may have to wait up to 4-5 business days to receive your permit number and will be charged a service fee. If you want your permit immediately please visit the Sheriff's office in person.

41. **This is an application only. Please pay online above or remit payment for permit to the Sheriff's office. The $20 annual fee can be paid in cash, check or credit card when paying in person at 2270 South Dale E. Nelson Drive, Beaver, UT OR by mail PO BOX 391 Beaver, UT 84713
43. Credit Card Confirmation Number:
    If you paid online please enter your credit card confirmation number here.
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field