Ill. Admin. Code tit. 17, pt. 525, exh. A
Part 1. Personal Data
Representing the following company, organization or governmental body (if applicable):
_________________________________________________________
Part 2. Type of permit applied for (check one):
Class A (Commercial - Mammals and Game Birds)
Class B* (Zoos and Botanical Gardens or landowners and tenants applying for take of migratory birds on their property in accordance with a federal permit)
Class C (Governmental - Mammals and Game Birds Only)
Class D (Commercial - Migratory Birds)
Class E (Governmental - Migratory Birds)
* Zoos and botanical garden must attach a copy of their Internal Revenue Service tax-exempt status determination letter, professional accreditation, and a map or legal description of their properties where wildlife will be controlled; landowners and tenants desiring to take migratory birds on their property must attach a copy of their Federal permit.
Part 3. Work Area (Applicants for Class A and D Permits only) A list of permittees is distributed to District Wildlife Biologists and Conservation Police Officers so that they can refer complainants to permittees who service that area. Please list (in order of preference) up to four counties that you service. This list will be used strictly for referrals; your activities are not restricted to this area.
County 1 ___________________________________________________________
County 2 ___________________________________________________________
County 3 ___________________________________________________________
County 4 ___________________________________________________________
I certify that all information provided on this application is true and correct to the best of my knowledge.
_________________________
Applicant's Signature
RETURN COMPLETED APPLICATIONS TO:
Illinois Department of Natural Resources
Division of Wildlife Resources
One Natural Resources Way
Springfield IL 62702-1271
Ill. Admin. Code tit. 17, pt. 525, exh. A