AFFIDAVIT for SCIENTIFIC and EDUCATIONAL COLLECTION PERMITS  

I, ________________________________________________________________, possess the ability to correctly identify federally protected and rare
species while in the field.  (Please circle one or all of the groups or species below that you are requesting to collect.)
 

Bats
Mussels
Copperbelly Watersnakes
Fishes (in watersheds known to harbor threatened and endangered species)
Other _______________________________________________

 

Description: _____________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

 

I, ________________________________________________________________________, declare under the penalty of perjury that the above statements are true and correct.

 

 

Acknowledged before me this ____________ day of ____________________, _____________.

 

Commission expires on: _________________________

 

___________________________________
Notary Public