MMDI Tag Replacement Form – The Confederacy of Mainland Mi'kmaq

Your information

Client Name
Street Address
City
Province
Postal Code
Fin #
Vessel #
Fishing Port
Vessel Name
License #
Species
Area
Captain

Fisher Declaration

I, (name)
of (village/town)
in (county)
do solemly declare that on the following date:
I have (indicate what happened to tags)
The tag numbers to be replaced are:
Or
from:
to:
I understand that the tag numbers identified above are void as of the date and time of submission of this form.

Fieldset

Only complete this if you are designating another person to pick up your tags.
I,
hereby authorize
to pick up tags on my behalf.
I understand that I am responsible for the proper control of these tags from the time they are issued.

Verification

Please enter any two digits *Example: 12
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