Form DEP-WILD-APP-002 "Application for License to Practice Taxidermy" - Connecticut

What Is Form DEP-WILD-APP-002?

This is a legal form that was released by the Connecticut Department of Energy and Environmental Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 2, 2010;
  • The latest edition provided by the Connecticut Department of Energy and Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DEP-WILD-APP-002 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Energy and Environmental Protection.

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Download Form DEP-WILD-APP-002 "Application for License to Practice Taxidermy" - Connecticut

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STATE OF CONNECTICUT
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF NATURAL RESOURCES
Application for License to Practice Taxidermy
DEP USE ONLY
Permit No.
Deposit Ref.
Part I: Applicant Information
Name:
Mailing Address:
City/Tow n:
State:
Zip Code:
Business Phone:
ext.
Fax:
I expect to conduct my business as a Taxidermist at:
Part II: Fee Information
The application fee for the License to Practice Taxidermy is $105.00
Part III: Certification
“I hereby make application for a license to practice taxidermy.
I certify that I will permit, at any time, any Law Enforcement Officer to examine and inspect any premises used
by me for the practice of taxidermy or for the storage of specimens.
I agree to make an annual report to the Department of Environmental Protection of the number and species of
birds and quadrupeds mounted.
I am a citizen of the United States and a bona fide resident of Connecticut.
I certify that this application is on complete and accurate forms as prescribed by the commissioner without
alteration of the text.
I declare, under the penalties of false statement, that the submitted information is true, accurate and complete to
the best of my knowledge and belief.”
Signature of Applicant
Date
Name of Applicant (print or type)
Title (if applicable)
Please make check payable to the Department of Environmental Protection. Mail completed application and
fee to:
Department of Environmental Protection
License and Revenue Unit
79 Elm Street
Hartford, CT 06106-5127
Bureau of Natural Resources
DEP-WILD-APP-002
1 of 1
Rev.08/02/10
STATE OF CONNECTICUT
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF NATURAL RESOURCES
Application for License to Practice Taxidermy
DEP USE ONLY
Permit No.
Deposit Ref.
Part I: Applicant Information
Name:
Mailing Address:
City/Tow n:
State:
Zip Code:
Business Phone:
ext.
Fax:
I expect to conduct my business as a Taxidermist at:
Part II: Fee Information
The application fee for the License to Practice Taxidermy is $105.00
Part III: Certification
“I hereby make application for a license to practice taxidermy.
I certify that I will permit, at any time, any Law Enforcement Officer to examine and inspect any premises used
by me for the practice of taxidermy or for the storage of specimens.
I agree to make an annual report to the Department of Environmental Protection of the number and species of
birds and quadrupeds mounted.
I am a citizen of the United States and a bona fide resident of Connecticut.
I certify that this application is on complete and accurate forms as prescribed by the commissioner without
alteration of the text.
I declare, under the penalties of false statement, that the submitted information is true, accurate and complete to
the best of my knowledge and belief.”
Signature of Applicant
Date
Name of Applicant (print or type)
Title (if applicable)
Please make check payable to the Department of Environmental Protection. Mail completed application and
fee to:
Department of Environmental Protection
License and Revenue Unit
79 Elm Street
Hartford, CT 06106-5127
Bureau of Natural Resources
DEP-WILD-APP-002
1 of 1
Rev.08/02/10