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Wildlife Collectors Application - Application for 20 Wildlife

By Vernon Rogers,2014-05-07 09:42
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Wildlife Collectors Application - Application for 20 Wildlife

    Application for 20 Wildlife Collector’s Permit

     (enter year)

     Mail to: Missouri Department of Conservation Attn: Wildlife Collector Permits P.O. Box 180

     Jefferson City, MO 65102-0180

    --------------------------------------------------------------------------------------------------------------------------------------- READ: ? All persons who take or attempt to take wildlife for education, research or collections must possess a Wildlife Collector’s Permit or be in the presence of a Wildlife Collector’s Permit holder. Individuals assisting with your collecting when you are not present are required to have their own Wildlife Collector’s Permit.

You must complete all appropriate sections of this application or it will be returned to you, which will delay your

    receipt of the permit. Allow 6 weeks for processing. Wildlife Collector’s Permits expire December 31. A permit is required for collection of aquatic invertebrates (other than mollusks or crayfish) and terrestrial invertebrates

    ONLY if you are collecting Species of Conservation Concern or if you are collecting on Missouri Department of Conservation

    lands. See The Wildlife Code of Missouri, Rules 3 CSR 10-4.110, 3 CSR 10-9.110(1.B), and 3 CSR 10-11.110(2).

    http://www.sos.mo.gov/adrules/csr/current/3csr/3csr.asp

    ---------------------------------------------------------------------------------------------------------------------------------------

    Please indicate the type of permit you are requesting:

     Wildlife Collector’s Permit for Scientific Purposes. To collect, possess, mount, or preserve wildlife for

     scientific or educational purposes. May be granted to an authorized representative of a university, college, school,

     incorporated city, state or federal agency, publicly owned zoo, wildlife or research organization, or other

     qualified individuals. FEE: $5

     Wildlife Collector’s Permit for Special Collections of Wildlife. Issued to professionally qualified individuals

    who charge a fee for biological or environmental studies for specific projects where the potential results are of

    sufficient public value and interest to justify special collections of wildlife under certain conditions specified within the

    permit. FEE: $50

     Please indicate whether this is a:

     New Permit Renewal

    Please list any MDC employee involved in planning this study:

PAYMENT METHOD: Check enclosed (payable to MO Department of Conservation)

     Visa OR Mastercard Card No.:

     3-digit security code: Expiration Date: Signature :

1. APPLICANT INFORMATION:

    Name: Telephone Number :

     (please type or print)

    Mailing Address:

     (Street or Rural Route) (e-mail Address)

    (City) (State) (Zipcode)

    SPONSORING INSTITUTION:

(Mailing Address)

NAME and TITLE of Institutional Official (must be someone other than applicant; e.g., immediate supervisor):

     Phone: Email Address: Note: The Institutional Official listed above will be contacted.

2. COLLECTION PURPOSE: Salvage Only (NOTE: no live specimens may be pursued or taken.)

     Educational/Class Exercise Museum Collection

     Scientific Research * Biomonitoring/Environmental Assessment *

     Other (specify):

    *Copy of research proposal must accompany requests for Biomonitoring/Environmental Assessment and

    Scientific Research activities.

3. NUMBER OF COLLECTING TRIPS:

     Fewer than five Up to twenty Up to fifty More than fifty (No. trips over 50 = ).

4. LOCATION: County or counties where collection activities will occur; you must provide justification for

     “regional” or “statewide” requests. If collecting aquatic species, specify basin, drainage, or stream.

    List Counties List Basin, Drainage or Stream

NOTE: No fish or aquatic invertebrates may be collected from streams in Barton, Benton, Boone, Camden, Cedar, Cooper,

    Dallas, Daviess, Greene, Grundy, Harrison, Hickory, Maries, Miller, Moniteau, Osage, Polk, St. Clair, or Webster counties

    without justification of need in Section 5 or on a separate sheet (these counties encompass the known ranges for the Niangua Darter and

    Topeka Shiner).

    Do you plan to collect on Department of Conservation land? NO YES List Area Name List Targeted Species on Each Area

Do you plan to collect in Caves? NO YES

    List Cave Name and Location List Targeted Species in Each Cave

5. JUSTIFY NEED/VALUE of the proposed collecting in the space below. Provide a brief summary of your activities,

    including a list of target species. You must provide a summary for each Conservation Area in which you will be working. If

    you intend to collect on a designated Natural Area, you must specify each Area and justify need (attach additional sheets as needed). If any species listed in (B) below are Missouri Species of Conservation Concern, be sure to provide details in Section 7.

(A) Your Qualifications:

(B) Species your efforts will target:

    (C) Means of collecting and handling specimens, including any marking to be done:

(D) Preservation methods and storage location:

     2

    6. FAUNAL GROUPS: For each group listed below:

    A) Check the number of specimens you expect to capture from each group during the permitted year. **Numbers marked with an asterisk (*) must be released unharmed at point of capture unless additional

    justification is attached. NOTE: Missouri Species of Conservation Concern must be listed under Section 7.

    B) Estimate the maximum number of specimens to be permanently removed from each group during the

    permitted year. If you do not specify a number, we will enter “zero” . Total number removed should include

    by-catch and salvaged specimens.

    By-catch refers to non-targeted specimens captured. By-catch must be included in number

    removed if you anticipate that mortality will occur.

    C) Estimate the maximum number of specimens to be salvaged from each group during the

     permitted year.

    Salvage is the taking of specimens found dead or dying due to actions other than your own.

     If you intend to salvage specimens, they cannot be your own by-catch.

    D) Check the appropriate box(es) to indicate the Specimen Collecting Methods (see below);

    E) Indicate the Disposition(s) of animals captured. Note: “Held in captivity” is a temporary condition, and

    animals removed from the wild and held in captivity for any length of time are not to be returned to the wild

    unless specifically approved on the permit. This practice is intended to avoid spreading disease and

    geographically mixing species and genetic stocks. Animals not able to be returned should be euthanized

    according to respective academic or agency compliance protocols.

MOLLUSKS CRAYFISHES

    A.1 fewer than ten mussels fewer than ten

     up to twenty mussels up to twenty

     more than twenty mussels* up to fifty

     number to be captured if > 20 more than fifty *

     number to be captured if > 50 A.2 fewer than ten gastropods

     up to twenty gastropods

     more than twenty gastropods *

     number to be captured if > 20

    B.1 Number of mussels permanently removed: Number permanently removed:

B.2 Number gastropods permanently removed:

    C. 1 Number of mussels salvaged: Number of crayfish salvaged:

C. 2 Number of gastropods salvaged:

    D. Method (check all that apply): Method (check all that apply):

     Legal Methods (see Wildlife Code) Legal Methods (see Wildlife Code)

     Hand Hand

     Trap Trap

     Seine Seine

     Dredge Dredge

     Net (other than mist net; daily attendance required) Net (other than mist net; daily attendance required)

     Specify type: Specify type:

     By-catch By-catch

     Salvage Salvage

     Other (specify) Other (specify) E. Disposition (check all that apply): Disposition (check all that apply):

     Studied and released unharmed at point of capture Studied and released unharmed at point of capture

     Mark/Release/Recaptured Mark/Release/Recaptured

     Held in captivity for: days Held in captivity for: days

     Tissue sample removed Tissue sample removed

     Killed for study purposes Killed for study purposes

     3

    OTHER AQUATIC INVERTEBRATES TERRESTRIAL INVERTEBRATES (check only if collecting Species of Conservation Concern (check only if collecting Species of Conservation Concern

    or on MDC land) or on MDC land)

     A. fewer than ten fewer than ten

     up to one hundred up to one hundred

     up to five hundred* up to five hundred*

     more than five hundred * more than five hundred*

     number to be captured if > 500 number to be captured if > 500

    B. number permanently removed: number permanently removed:

    C. Number of aquatic invertebrates salvaged: Number of terrestrial invertebrates salvaged: D. Method (check all that apply): Method (check all that apply):

     Legal Methods (see Wildlife Code) Legal Methods (see Wildlife Code)

     Hand Hand

     Trap Trap

     Seine Seine

     Dredge Dredge

     Net (other than mist net; daily attendance required) Net (other than mist net; daily attendance required)

     Specify type: Specify type:

     By-catch By-catch

     Salvage Salvage

     Other (specify) Other (specify) E. Disposition (check all that apply): Disposition (check all that apply):

     Studied and released unharmed at point of capture Studied and released unharmed at point of capture

     Mark/Release/Recaptured Mark/Release/Recaptured

     Held in captivity for: days Held in captivity for: days

     Tissue sample removed Tissue sample removed

     Killed for study purposes Killed for study purposes

    FISHES - EGGS/LARVAE FISHES - JUVENILES/ADULTS A. fewer than ten fewer than ten

     up to twenty up to twenty

     up to fifty * up to fifty *

     more than fifty* more than fifty*

     number to be captured if >50 number to be captured if >50 B. number permanently removed number permanently removed

C. Number of fish salvaged:

     D. Method (check all that apply):

     Legal Methods (see Wildlife Code)

     Hand

     Trap

     Seine

     Dredge

     Net (other than mist net; daily attendance required); Specify type:

     Electrofishing (DC only)

     By-catch

     Salvage

     Other (specify)

    E. Disposition (check all that apply):

     Studied and released unharmed at point of capture

     Mark/Release/Recaptured

     Held in captivity for: days

     Tissue sample removed

     Killed for study purposes

     4

    AMPHIBIANS REPTILES BIRDS (Federal Permit Also Required) A. fewer than ten fewer than ten fewer than ten

     up to twenty up to twenty up to twenty

     up to fifty* up to fifty* up to fifty *

     more than fifty* more than fifty * more than fifty *

     number to be captured if >50 number to be captured if > 50 number to be captured if > 50

    B. number permanently removed: number permanently remove d: number permanently removed : C. Number of amphibians salvaged: Number of reptiles salvaged: Number of birds salvaged: D. Method (check all that apply): Method (check all that apply): Method (check all that apply):

     Legal Methods (see Wildlife Code) Legal Methods (see Wildlife Code) Legal Methods (see Wildlife Code)

     Hand Hand Hand

     Trap Trap Trap

     Seine Seine Net (other than mist net; daily

     Net (other than mist net; daily Net (other than mist net; daily attendance required)

     attendance required) attendance required) Specify type:

     Specify type: Specify type: Mist Net (constant attendance

     Electrofishing (DC only) Firearms required)

     Firearms By-catch Firearms

     By-catch Salvage By-catch

     Salvage Other (specify) Salvage

     Other (specify) Other (specify) E. Disposition (check all that apply): Disposition (check all that apply): Disposition (check all that apply):

     Studied and released unharmed at Studied and released unharmed at Studied and released unharmed at

     point of capture point of capture point of capture

     Mark/Release/Recaptured Mark/Release/Recaptured Mark/Release/Recaptured

     Held in captivity for: days Held in captivity for: days Held in captivity for: days

     Tissue sample removed Tissue sample removed Tissue sample removed

     Killed for study purposes Killed for study purposes Killed for study purposes

    MAMMALS (other than bats or deer) BATS WHITE-TAILED DEER A. fewer than ten fewer than ten fewer than ten

     up to twenty up to twenty up to twenty

     up to fifty* up to fifty* up to fifty *

     more than fifty* more than fifty * more than fifty *

     number to be captured if > 50 number to be captured if > 50 number to be captured if > 50

    B. number permanently removed: number permanently remove d: number permanently removed:

    C. Number of mammals salvaged: Number of bats salvaged: Number of deer salvaged: D. Method (check all that apply): Method (check all that apply): Method (check all that apply):

     Legal Methods (see Wildlife Code) Legal Methods (see Wildlife Code) Legal Methods (see Wildlife Code)

     Hand Hand Hand

     Trap Harp Trap (constant attendance Trap

     Firearms required) Firearms

     By-catch Mist Net (constant attendance By-catch

     Salvage required) Salvage

     Other (specify) By-catch Other (specify)

     Salvage

     Other (specify)

    E. Disposition (check all that apply): Disposition (check all that apply): Disposition (check all that apply):

     Studied and released unharmed at Studied and released unharmed at Studied and released unharmed at

     point of capture point of capture point of capture

     Mark/Release/Recaptured Mark/Release/Recaptured Mark/Release/Recaptured

     Held in captivity for: days Held in captivity for: days Held in captivity for: days

     Tissue sample removed Tissue sample removed Tissue sample removed

     Killed for study purposes Killed for study purposes Killed for study purposes

     5

7. Will your activities target any SPECIES OF CONSERVATION CONCERN?

     Yes No

    If Yes, complete the following section. This section applies to all rare, imperiled, state or

    federally endangered species listed in the Missouri Species and Communities of Conservation Concern

    Checklist (http://mdc4.mdc.mo.gov/Documents/145.pdf). This list is updated annually so it should be reviewed before completing this application.

     Attach project proposal and/or justification for work pertaining to species of

     conservation concern (attach additional sheets as necessary).

    Common Name Scientific Name Quantity-Quantity-permanently

    captured/released removed

8. A FEDERAL PERMIT is also required to collect MIGRATORY and/or FEDERALLY

     ENDANGERED OR THREATENED WILDLIFE. CONTACT: The U.S. Fish & Wildlife Service,

     Migratory Bird Permit Office, One Federal Drive, Fort Snelling, MN 55111. (Telephone (612) 713-5436,

     e-mail permitsR3MB@fws.gov)

    FEDERAL PERMIT NO.:

A Missouri Wildlife Collector’s Permit does not relieve you of compliance with other state and federal regulations

    and does not authorize trespass. Collecting on public lands not owned by the Missouri Department of

    Conservation requires that you obtain a separate permit from the managing agency.

    9. WILDLIFE COLLECTOR REPORT FOR PREVIOUS YEAR: List specimens collected, including those captured

     and released, on your last permit and include: 1) Common name 2) Scientific name 3) Date(s) collected 4) Quantity

     (number) collected and 5) Specific, identifiable location where collected. (A report form was sent with your collector permit or a

     form can be printed from http://www.mdc.mo.gov/regs/or you may attach a summary report that contains this information.) For

     Species of Conservation Concern, please complete a Rare Animal Reporting Form (found in the Missouri Species and Communities of

     Conservation Concern Checklist) for each observation/capture/collection. FAILURE TO PROVIDE THIS REPORT

     WILL RESULT IN THE DENIAL OF FUTURE PERMIT REQUESTS.

Note: The information you collect is very important and contributes to the body of knowledge regarding our natural

    resources. We require that you share your information with us so that we can better manage our fish and wildlife resources.

11. Signature of Applicant Date

Your application and/or report form can be submitted electronically, faxed to 573-751-4864 or mailed to the address on the

    front page. To submit electronically, fill out this form and Save As Your Name.doc (i.e., JohnDoe.doc), then e-mail to Collector.permit@mdc.mo.gov

    JAF 10-09

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