Form SLAP22.42 "Application for Wildlife Rehabilitation Permit" - Nevada

What Is Form SLAP22.42?

This is a legal form that was released by the Nevada Department of Wildlife - a government authority operating within Nevada. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on October 1, 2016;
  • The latest edition provided by the Nevada Department of Wildlife;
  • 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 SLAP22.42 by clicking the link below or browse more documents and templates provided by the Nevada Department of Wildlife.

ADVERTISEMENT
ADVERTISEMENT

Download Form SLAP22.42 "Application for Wildlife Rehabilitation Permit" - Nevada

1225 times
Rate (4.4 / 5) 61 votes
____________________________________________________________________________________________________________
Application
Wildlife Rehabilitation Permit
Fee: $0 (22.42)
2-Year
Permit expires December 31.
Mark the appropriate space, then read and follow the instructions:
(____) New Application: Complete the entire Applicant Information box, sign, date and submit.
(____) Renewal: Complete the entire Applicant Information block and Sections F, G, H, I, & J; then include
any other changes or additions where appropriate; sign, date and submit.
Please PRINT all information except for your signature. Incomplete or illegible applications will be
returned. PROCESSING TIME: Allow thirty (30) days.
SLAP Entity ID (Special Permit and License ID) - New applicants SLAP ID will be assigned when the
permit is issued.
Federal Tax ID or SSN only required for new applicants.
I
B
E
I
-
NSTITUTION OR
USINESS
NTITY
NFORMATION
(Institution or business entity the permit is for.)
I
B
E
:
(If same as responsible party indicate SAME)
SLAP Entity ID
NSTITUTION OR
USINESS
NTITY NAME
MAILING ADDRESS:
FEDERAL TAX ID:
CITY:
STATE:
ZIP:
E-MAIL ADDRESS:
PHYSICAL ADDRESS:
CITY:
STATE:
ZIP:
TELEPHONE:
R
P
– Person responsible for permit
ESPONSIBLE
ARTY
NAME [LAST]
[FIRST]
[MIDDLE]
SLAP Entity ID
MAILING ADDRESS:
SSN
CITY:
STATE:
ZIP:
E-MAIL ADDRESS:
PHYSICAL ADDRESS:
CITY:
STATE:
ZIP:
TELEPHONE:
HEIGHT:
WEIGHT:
HAIR:
EYES:
GENDER:
DRIVER’S LICENSE NUMBER
STATE:
DATE ISSUED:
OCCUPATION:
EMPLOYER:
WORK ADDRESS:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.42
Rev. Oct 2016
Page 1 of 4
____________________________________________________________________________________________________________
Application
Wildlife Rehabilitation Permit
Fee: $0 (22.42)
2-Year
Permit expires December 31.
Mark the appropriate space, then read and follow the instructions:
(____) New Application: Complete the entire Applicant Information box, sign, date and submit.
(____) Renewal: Complete the entire Applicant Information block and Sections F, G, H, I, & J; then include
any other changes or additions where appropriate; sign, date and submit.
Please PRINT all information except for your signature. Incomplete or illegible applications will be
returned. PROCESSING TIME: Allow thirty (30) days.
SLAP Entity ID (Special Permit and License ID) - New applicants SLAP ID will be assigned when the
permit is issued.
Federal Tax ID or SSN only required for new applicants.
I
B
E
I
-
NSTITUTION OR
USINESS
NTITY
NFORMATION
(Institution or business entity the permit is for.)
I
B
E
:
(If same as responsible party indicate SAME)
SLAP Entity ID
NSTITUTION OR
USINESS
NTITY NAME
MAILING ADDRESS:
FEDERAL TAX ID:
CITY:
STATE:
ZIP:
E-MAIL ADDRESS:
PHYSICAL ADDRESS:
CITY:
STATE:
ZIP:
TELEPHONE:
R
P
– Person responsible for permit
ESPONSIBLE
ARTY
NAME [LAST]
[FIRST]
[MIDDLE]
SLAP Entity ID
MAILING ADDRESS:
SSN
CITY:
STATE:
ZIP:
E-MAIL ADDRESS:
PHYSICAL ADDRESS:
CITY:
STATE:
ZIP:
TELEPHONE:
HEIGHT:
WEIGHT:
HAIR:
EYES:
GENDER:
DRIVER’S LICENSE NUMBER
STATE:
DATE ISSUED:
OCCUPATION:
EMPLOYER:
WORK ADDRESS:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.42
Rev. Oct 2016
Page 1 of 4
Sections A - L. (Use additional sheets if you need more room, reference the Section, and attach to
the application)
A.
Provide the physical address (street & town/city) or legal description (where no address exists) for each
location where the facilities to rehabilitate wildlife will be located:
1.
2.
3.
B.
Which specific species or taxa of wildlife are you requesting to rehabilitate?
1.
I wish to rehabilitate only the following species:
OR
2.
Taxa:
Amphibians
Reptiles
Birds other than eagles, hawks and owls
Eagles, hawks and owls
Mammals
Black bear (NOTE: Special facilities are required for bear, mountain lion, & bobcats)
Mountain lion
Bobcat
C.
Provide a detailed description of the experience which you have in working with each taxa or species
requested above in section B, including, but not limited to:
(Complete #1., #2., & #3, below)
1. Previous experience, which can be verified (provide names & phone #'s), in rehabilitating wildlife:
2.
Assistance to a person (provide name & phone #) who holds a current license or permit to
rehabilitate wildlife:
3. Assistance to a licensed veterinarian (name & phone no.) who has routinely worked on wildlife:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.42
Rev. Oct 2016
Page 2 of 4
D.
Yes.
No. Do you currently hold a rehabilitation license or permit in another state? If "Yes", list
the name of each state:
E.
Yes.
No. Have you held a similar license or permit in another state? If "Yes", list the name of
each state:
F.
Yes.
No. Within the 5 years preceding the date of this application, have you been convicted of
violating the wildlife laws or regulations of any state or the U.S. Fish and Wildlife Service? If "Yes" but
you did report this on your last application, go to #G. If "Yes", but you did not previously report this,
provide the information below (list all convictions):
Date convicted:
Where convicted:
Convicted of:
G.
Yes.
No. Is your privilege to rehabilitate wildlife revoked or suspended in any other state? If
"Yes", list the state(s):
H.
Yes.
No. Is your privilege to rehabilitate wildlife revoked or suspended by the U.S. Fish &
Wildlife Service? If "Yes", list the beginning and ending dates of revocation/suspension:
I.
Provide the name, physical address and telephone number of each person who will routinely transport
wildlife or assist you at the facility (or facilities) where the wildlife will be rehabilitated:
Name:
Phone:(
)
Address:
Name:
Phone:(
)
Address:
Name:
Phone:(
)
Address:
J.
Provide the name, business address, telephone number and signature of the practicing veterinarian,
licensed in this state, who will examine, diagnose and perform veterinary services on and, if required,
euthanize the injured, ill orphaned or otherwise debilitated wildlife:
Veterinarian's Name:
Business Address:
Business Telephone:(
)
Veterinarian's Signature:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.42
Rev. Oct 2016
Page 3 of 4
K.
Attach or enclose a copy of your federal permit, issued by the U. S. Fish & Wildlife Service, if you are
presently rehabilitating or proposing to rehabilitate migratory birds. (or indicate if the permit is pending)
L.
Attach a complete description, including a diagram, of the holding facilities, cages or aquaria that will be
used to confine the wildlife. (Disregard this if you are renewing and there are no taxa or facility
changes)
M.
ATTACH one of the following:
1. Documentation which substantiates that you have at least 2 years of practical experience working
with a licensed rehabilitator;
OR
2. A letter which is written by a licensed veterinarian who is experienced in the care of wildlife and
which substantiates the qualifications of the applicant to rehabilitate wildlife.
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
Submit your completed application to:
Nevada Department of Wildlife
License Office – Rehabilitation Permit Application
6980 Sierra Center Pkwy, Ste-120
Reno, NV 89511
FOR DEPARTMENT USE ONLY
Department Representative:
Date Received: _______________
Date Approved: _______________
Date Returned for Additional Information: _______________
Date Disapproved: _______________
Letter Sent:
REASON FOR DISAPPROVAL:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.42
Rev. Oct 2016
Page 4 of 4
Page of 4