Fillable Massachusetts mass wildlife Application for Commercial Scientific Collection Permit

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Massachusetts mass wildlife Application for Commercial Scientific Collection Permit

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The Massachusetts mass wildlife Application for Commercial Scientific Collection Permit form is 2 pages long and contains:

  • 1 signature
  • 10 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Application for Commercial Scientific Collection Permit
This Permit Application is for the Scientific Collection of:
____Mammals ____Fish
____Birds ____Invertebrates
____Reptiles & Amphibians ____Plants
If this application is for birds, do you have a Migratory Bird Permit? Y___ N___ If yes, Permit #: ________
Please submit separate applications for each taxonomic group.
Fee: $100/permit. Please make checks payable to Comm. of MA – NHESP.
Permit Holder Information:
Name: __________________________________________________ Date of Birth: _________________
Home address: ________________________________________________________________________
Home phone: ________________________ Cell phone: _____________________________
Business address: ______________________________________________________________________
Business phone: ______________________ Email: ___________________________________________
State specifically the number and species of animals or plants to be collected and/or possessed:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Is this collection/possession being undertaken in relation to a proposed project that has been or will be
undergoing a NHESP regulatory review? Y____ N____ If yes, NHESP tracking #:____________________
Did you have a NHESP approved survey protocol? Y___ N___ Note: A NHESP approved survey protocol
may be required for regulatory review.
Institution to which collected specimens will be donated: ____________________________________
___________________________________________________________________________________
Location of where collections will be made (attach a map with the site location clearly marked and
centered on the page): ________________________________________________________________
Desired start date: ______________________________________________________
State your qualifications and enclose an outline of your proposed study including site specific
methodology and survey protocols: _________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Name(s) of any subpermittee(s):___________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I certify that the information provided above is true and correct to the best of my knowledge and belief.
_____________________________________________________________________________________
Signature of applicant Date
Note: Permit will expire on December 31 of year issued.
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Massachusetts mass wildlife Application for Commercial Scientific Collection Permit

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Completed 18 February 2020

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