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| NAME……………………………………………………………………………………... |
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| FISH
(common name)……………………………………………………………………. |
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| FISH
(scientific name)…………………………………………………………………….. |
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| DATE CAUGHT…………………………….. |
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| LOCATION …………………………………………………………………………………… |
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| WEIGHT………………………………………... |
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| CERTIFIED SCALE No………………………………… |
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| WEIGHED BY…………………………………………. |
SIGNATURE………………………………… |
| ADDRESS
……………………………………………… |
DATE………………………………………. |
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……………………………………………… |
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…………………………………………….. |
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| APPLICANTS SIGNATURE……………………………………………………. |
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| VERIFICATION BY………………………………………………………………. |
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| CLUB RECORDERS SIGNATURE……………………………………………… |
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