"Wildlife Rehabilitation Permit Renewal Request Form" - New Hampshire

Wildlife Rehabilitation Permit Renewal Request Form is a legal document that was released by the New Hampshire Fish and Game Department - a government authority operating within New Hampshire.

Form Details:

  • Released on March 26, 2004;
  • The latest edition currently provided by the New Hampshire Fish and Game Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Fish and Game Department.

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Download "Wildlife Rehabilitation Permit Renewal Request Form" - New Hampshire

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NEW HAMPSHIRE FISH AND GAME DEPARTMENT
11 HAZEN DRIVE
CONCORD, NH 03301
WILDLIFE REHABILITATION PERMIT RENEWAL REQUEST FORM
Please Print Name
Ph:
Mailing Address
Physical Address if different from Mailing
City
ST
Zip
Federal Rehabilitation Permit No.
(Required to rehabilitate migratory birds)
Applicant's Signature
Date
INDEMNIFICATION STATEMENT
(SIGNATURE REQUIRED TO REHAB RABIES VECTOR SPECIES)
I hereby agree to indemnify the New Hampshire Fish and Game Department from all losses, injury
and damage to persons or property resulting from acts or omissions on my part, and assume full
liability and responsibility for myself and my assistants in the care of and contact with Rabies
Vector Species (raccoons, woodchucks, fox, skunks and bats)
Signature
Date
Licensed Consulting Veterinarian - (
)
Concurrence with Issuance of Renewal Permit
I,
hereby concur with the issuance of a renewal permit
(Please print name here)
to the above-named applicant.
Veterinarian's Signature
Facility
NOTE: This renewal request does not allow for rehabilitation of any new species not previously listed
on your current permit. Any changes or additions that you wish to make must be documented to and
approved by the Department.
Rev. 3/26/04 (Added Indemnification Statement)
NEW HAMPSHIRE FISH AND GAME DEPARTMENT
11 HAZEN DRIVE
CONCORD, NH 03301
WILDLIFE REHABILITATION PERMIT RENEWAL REQUEST FORM
Please Print Name
Ph:
Mailing Address
Physical Address if different from Mailing
City
ST
Zip
Federal Rehabilitation Permit No.
(Required to rehabilitate migratory birds)
Applicant's Signature
Date
INDEMNIFICATION STATEMENT
(SIGNATURE REQUIRED TO REHAB RABIES VECTOR SPECIES)
I hereby agree to indemnify the New Hampshire Fish and Game Department from all losses, injury
and damage to persons or property resulting from acts or omissions on my part, and assume full
liability and responsibility for myself and my assistants in the care of and contact with Rabies
Vector Species (raccoons, woodchucks, fox, skunks and bats)
Signature
Date
Licensed Consulting Veterinarian - (
)
Concurrence with Issuance of Renewal Permit
I,
hereby concur with the issuance of a renewal permit
(Please print name here)
to the above-named applicant.
Veterinarian's Signature
Facility
NOTE: This renewal request does not allow for rehabilitation of any new species not previously listed
on your current permit. Any changes or additions that you wish to make must be documented to and
approved by the Department.
Rev. 3/26/04 (Added Indemnification Statement)