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Bighorn National Forest

Transplant Permit By Mail

TONGUE RANGER DISTRICT

2013 Eastside 2

St.

Sheridan, WY 82801

Phone: (307) 674-2600

Form No. 0202-2460-1c (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.

Nam

(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 transplants: (4 minimum and 5 maximum)

Total fee enclosed: $ 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: 4 Transplants = $20 or 5 Transplants = $25

Number of Aspen:

Number of Conifers:

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 permit 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

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