Form SLAP22.39 "Aerial Depredation Permit Application" - Nevada

What Is Form SLAP22.39?

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 January 1, 2017;
  • 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 SLAP22.39 by clicking the link below or browse more documents and templates provided by the Nevada Department of Wildlife.

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Download Form SLAP22.39 "Aerial Depredation Permit Application" - Nevada

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__________________________________________________________________________________________________________
APPLICATION
AERIAL DEPREDATION PERMIT
Fee: $0
(22.39)
2-YEAR
Permit expires December 31.
Please PRINT all information except for your signature. Incomplete or illegible applications may be returned.
PROCESSING TIME: Allow up to 30 days for applications which do not require clarification, additional
information, or investigation.
Please PRINT all information except for your signature. Incomplete or illegible applications will be
returned.
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 hereby make application for:
(Mark the appropriate box and then read and follow the instructions.)
New application: Complete the entire applicant information block and all sections. Sign and date the
application.
Renewal of last year’s PERMITTED projects: Complete the entire applicant information block and then
complete all other sections in the application where changes are being requested. CLEARLY DESCRIBE
CHANGES. Sign and date the application.
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:
_________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.39
Rev. Jan 2017
Page 1 of 3
__________________________________________________________________________________________________________
APPLICATION
AERIAL DEPREDATION PERMIT
Fee: $0
(22.39)
2-YEAR
Permit expires December 31.
Please PRINT all information except for your signature. Incomplete or illegible applications may be returned.
PROCESSING TIME: Allow up to 30 days for applications which do not require clarification, additional
information, or investigation.
Please PRINT all information except for your signature. Incomplete or illegible applications will be
returned.
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 hereby make application for:
(Mark the appropriate box and then read and follow the instructions.)
New application: Complete the entire applicant information block and all sections. Sign and date the
application.
Renewal of last year’s PERMITTED projects: Complete the entire applicant information block and then
complete all other sections in the application where changes are being requested. CLEARLY DESCRIBE
CHANGES. Sign and date the application.
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:
_________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.39
Rev. Jan 2017
Page 1 of 3
1. Purpose: I request this permit for the purpose of protecting: (Check all that apply.)
Domestic animals.
Land. Explain: ___________________________________________
Livestock.
Public Safety. Explain the nature of the threat:
Wildlife.
_______________________________________________________
2. Damage: If you are requesting a permit for the purpose of protecting livestock, wildlife, or domestic
animals. Indicate the approximate number of each type of animal that was lost in the past 12 months and the
associated value of the loss:
Type
Number Lost
Total Value
Cattle
____________
____________
Sheep
____________
____________
Swine
____________
____________
Poultry
____________
____________
Dogs
____________
____________
Cats
____________
____________
Other: ______________
____________
____________
Other: ______________
____________
____________
3. Location of Intended Control: Provide the name of each federal grazing allotment and county(ies) of it’s
location where aerial control will take place during periods of active use by the permittee’s livestock; and the
name and location of private holdings where aerial control will occur. (NOTE: The permit will be limited to
Federal grazing allotments where the applicant has active use by his livestock, and the applicant’s private
land.)
__________________________________ Allotment(s) in ___________________________ County.
__________________________________ Allotment(s) in ___________________________ County.
__________________________________ Allotment(s) in ___________________________ County.
__________________________________ Ranch/property in ________________________ County.
__________________________________ Ranch/property in ________________________ County.
__________________________________ Ranch/property in ________________________ County.
4. Pilot(s) Information:
(a) Name: ________________________________________________________________________
Address: ______________________________________________________________________
Phone Number: _________________________________________________________________
(b) Name: ________________________________________________________________________
Address: ______________________________________________________________________
Phone Number: _________________________________________________________________
(c) Name: ________________________________________________________________________
Address: ______________________________________________________________________
Phone Number: _________________________________________________________________
5. Aircraft Description:
_________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.39
Rev. Jan 2017
Page 2 of 3
(a) Make: ___________________ Model: _________________ Color(s): ___________________
Registration Number: ____________________________________________________________
Location/address where aircraft will be based: _________________________________________
(b) Make: ___________________ Model: _________________ Color(s): ___________________
Registration Number: ____________________________________________________________
Location/address where aircraft will be based: _________________________________________
(c) Make: ___________________ Model: _________________ Color(s): ___________________
Registration Number: ____________________________________________________________
Location/address where aircraft will be based: _________________________________________
6.
If issued a permit, estimate the number of coyote which will be killed the remainder of this calendar year
and the following calendar year.
Coyote
This year: __________
Next year: __________
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 Application to:
Nevada Department of Wildlife
License Office – Aerial Depredation
6980 Sierra Center Pkwy, Ste-120
Reno, NV 89511
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 22.39
Rev. Jan 2017
Page 3 of 3
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