Fill - Free fillable Stelprd3845583 - bnf_mailin_dead_postpoles

Bighorn National Forest

Dead Post and Poles Permit By Mail

TONGUE RANGER DISTRICT

2013 Eastside 2

St.

Sheridan, WY 82801

Phone: (307) 674-2600

Form No. 0202-2460-1e (12/11)

POWDER RIVER RANGER DISTRICT

1415 Fort St.

Buffalo, WY 82834

Phone: (307) 684-7806

MEDICINE WHEEL RANGER DISTRICT

95 Highway 16/20

Greybull, WY 82426

Phone: (307) 765-4435

By requesting a permit by mail you are subject to, and in strict compliance with, all the general and other

conditions listed on the Bighorn National Forest website for this permit.

Name (Full name as it appears on the ID) Driver’s License, State-issued or Tribal ID ID Expiration Date

ddress (Street or PO Box)

ity State

Code

elephone Number

Number of load tickets 3 load tickets (= 20 poles each) minimum and 20 load tickets maximum

Dead post and poles can be harvested all year. Post and poles have a maximum of less than 7” diameter and

there is no maximum length.

Total fee (see rates below): $ . Enclose payment in the form of Personal Check, Money

Order, or Cashier’s Check, made payable to: USDA Forest Service. Do not send cash.

Rates:

Load Tickets Poles Cost Load Tickets Poles Cost

3 60 $27.00 4 80 $36.00

5 100 $45.00 6 120 $54.00

7 140 $63.00 8 160 $72.00

9 180 $81.00 10 200 $90.00

11 220 $99.00 12 240 $108.00

13 260 $117.00 14 280 $126.00

15 300 $135.00 16 320 $144.00

17 340 $153.00 18 360 $162.00

19 380 $171.00 20 400 $180.00

Your signature on this document is an acknowledgement of your responsibility to read and comply with all

permit requirements. Failure to comply with all requirements therein is a violation of 36 CFR 261.10(k),

and carries a maximum penalty of $5,000 and/or six months in jail.

Signature: _______________________________ Date___________

INSTRUCTIONS: ALL blocks MUST be filled in or the permi

t will not be issued via the mail.

Permit will be issued and sent back to you. Please sign where indicated on the permit and display on the

dashboard of your vehicle when cutting. Please review the information enclosed with your permit. If

you have any questions, call a District Office below.

FormNo.0202‐2460‐1a(12/11)

PERMITTEES:Ifapplicable,fillinthenameofthepersonyouaredelegatingtouseyourpermit,

andsignwhereitreads“Signature”inPart1.AForestOfficerwillcompletetherestoftheform

andreturnittoyouwithyourcompletedpermit.



USDAFORESTSERVICE

AUTHORIZATIONFORREMOVALOFFORESTPRODUCTS

Thefollowinginformationisbeingcollectedforthepurposeofproviding

reasonableaccommodationintheBighornNationalForest’sForestProducts

programunderTITLEVI,SECTION504OFTHECIVILRIGHTSACTOF1964and

SECTION502OFTHEREHABILITATIONACTOF1973

.

PART1‐PERMITEE:



Iherebyauthorize_________________________________________to

(Name)

cut,gather,andhaulForestProductsformeunderthetermsofPermitNumber___________



dated______________,tagnumbers:______________________.



AsPermittee,IunderstandthatIremainresponsibleforadherencetothetermsoftheabove‐

namedpermit,and

amnotrelievedofresponsibilitiesorliabilitiesassumedhereunder.



Signature:___________________________________________



PART2–FORESTOFFICER:



Iapprovethisauthorization.



  SIGNATURE:___________________________DATE__________

   (ForestOfficer)



AttachOriginaltoPermit

AttachCopytoOfficeCopyofPermit

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Stelprd3845583 - bnf_mailin_dead_postpoles_form

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Stelprd3845583 - bnf_mailin_dead_postpoles_form Form

Related forms

Fillable Stelprd3845583 - bnf_mailin_dead_postpoles_form

Fill Online, Printable, Fillable, Blank Stelprd3845583 - bnf_mailin_dead_postpoles_form Form

Related forms

First 20 documents completely FREE!