Form SLAP 22.91 Application for Wildlife Exportation Permit - Nevada

Form SLAP22.91 or the "Application For Wildlife Exportation Permit" is a form issued by the Nevada Department of Wildlife.

The form was last revised in October 1, 2010 and is available for digital filing. Download an up-to-date Form SLAP22.91 in PDF-format down below or look it up on the Nevada Department of Wildlife Forms website.

ADVERTISEMENT
____________________________________________________________________________________________________________
APPLICATION
WILDLIFE EXPORTATION PERMIT
Fee: $15
(22.91)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
I hereby make application for a permit to export the following wildlife species out of the State of
Nevada.
APPLICANT/CONSIGNOR
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
INFORMATION
NAME [LAST]
[FIRST]
[MIDDLE]
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
HOME PHONE
WORK PHONE:
E-MAIL ADDRESS:
HEIGHT:
WEIGHT:
HAIR:
EYES:
GENDER:
DRIVER’S LICENSE NUMBER:
STATE:
DATE ISSUED:
Wildlife to be exported:
NUMBER
COMMON NAME
SCIENTIFIC NAME
How Obtained: ___________________________________________________________________________
Date Obtained: ___________________________________________________________________________
Destination of Shipment:
________________________________________________________________
Name of Consignee
__________________________________________________________________________________
__________________________________________
Address of Consignee
________________________________________________________________________________________
_____
Valid for 10 days beginning: _________________________________________________________, 20____
_________________________________________________________, 20____
_________________________________________________________, 20____
Certificate of clean health signed by an accredited veterinarian:
YES
NO
The purpose for exporting these species is: _____________________________________________________
I, the signator, in signing this application, hereby state that I am entitled to this permit under the laws of the State of
Nevada and that no false information or false statement has been made by me to obtain this license.
_____________________________________________________________
__________________________________
Signature of Applicant
Date
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.91
Rev. Oct 2010
Page 1 of 2
____________________________________________________________________________________________________________
APPLICATION
WILDLIFE EXPORTATION PERMIT
Fee: $15
(22.91)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
I hereby make application for a permit to export the following wildlife species out of the State of
Nevada.
APPLICANT/CONSIGNOR
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
INFORMATION
NAME [LAST]
[FIRST]
[MIDDLE]
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
HOME PHONE
WORK PHONE:
E-MAIL ADDRESS:
HEIGHT:
WEIGHT:
HAIR:
EYES:
GENDER:
DRIVER’S LICENSE NUMBER:
STATE:
DATE ISSUED:
Wildlife to be exported:
NUMBER
COMMON NAME
SCIENTIFIC NAME
How Obtained: ___________________________________________________________________________
Date Obtained: ___________________________________________________________________________
Destination of Shipment:
________________________________________________________________
Name of Consignee
__________________________________________________________________________________
__________________________________________
Address of Consignee
________________________________________________________________________________________
_____
Valid for 10 days beginning: _________________________________________________________, 20____
_________________________________________________________, 20____
_________________________________________________________, 20____
Certificate of clean health signed by an accredited veterinarian:
YES
NO
The purpose for exporting these species is: _____________________________________________________
I, the signator, in signing this application, hereby state that I am entitled to this permit under the laws of the State of
Nevada and that no false information or false statement has been made by me to obtain this license.
_____________________________________________________________
__________________________________
Signature of Applicant
Date
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.91
Rev. Oct 2010
Page 1 of 2
The completed application with the required fee may be submitted to any office of the Nevada Department of
Wildlife.
Western Region
Southern Region
Nevada Department of Wildlife
Nevada Department of Wildlife
Special Licenses and Permits
4747 Vegas Dr.; Las Vegas, NV 89108
1100 Valley Rd, Reno, NV 89512
Telephone: (702) 486-5127
Telephone: (775) 688-1500
Counties: Clark, Esmeralda, Lincoln, Nye
Counties: Carson City, Churchill, Douglas,
Humboldt, Lyon, Mineral, Pershing, Storey,
Washoe
Eastern Region
Nevada Department of Wildlife
60 Youth Center Road; Elko, NV 89801
Telephone: (775) 777-2300
Counties: Elko, Eureka, Lander, White Pine
FOR DEPARTMENT USE ONLY
Date Received: _______________
Date Approved: _______________
Date Returned for Additional Information: ________________________
Date Disapproved: _______________
Department Representative:___________________________________
REASON FOR DISAPPROVAL:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.91
Rev. Oct 2010
Page 2 of 2

Download Form SLAP 22.91 Application for Wildlife Exportation Permit - Nevada

609 times
Rate
4.8(4.8 / 5) 43 votes
ADVERTISEMENT
Page of 2