Form AG-00706 "Compensation Claim for Livestock Destroyed by Wolf" - Minnesota

What Is Form AG-00706?

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

Form Details:

  • Released on January 14, 2022;
  • The latest edition provided by the Minnesota Department of Agriculture;
  • 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 fillable version of Form AG-00706 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Agriculture.

ADVERTISEMENT
ADVERTISEMENT

Download Form AG-00706 "Compensation Claim for Livestock Destroyed by Wolf" - Minnesota

Download PDF

Fill PDF online

Rate (4.4 / 5) 19 votes
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Plant Protection, Ph: 651-201-6020, MN_MDA_elkandwolf@state.mn.us
Minn. Stat. 3.737, MN Rules Chapter 1515
Compensation Claim for Livestock Destroyed by Wolf
($100 minimum, $20,000 maximum, claim per livestock owner per fiscal year)
Claim #_____________________
Claimant Information (fill out completely)
Investigator Information
Entity Name (Print)
Investigator Name and Title (Print and fill out completely)
Mailing Address
Phone
Date of Complaint
City
State
Zip
Type of Complaint
Phone
Email
Contacted by
County Where Depredation Occurred
UTM Coordinate of Property
Or →
Legal Description of Depredation Site
E
N
T
R
S
Was the livestock covered by insurance?
YES
NO
if yes, policy #
Amount $
____________________________________
________________
Insurance Agent Name
Phone
Have you received compensation for this loss from any other source?
Yes
No
if yes, Amount $
_____________
Evidence Leading Claimant to Believe the Livestock was Destroyed by Wolf
If this is the first claim you have filed, or the first claim in several years, you will need to submit a W9 in order for payment to be made.
Signature, Livestock Owner / Date _________________________________________________________________________
I certify that the information included on this claim is true and accurate; and to the best of my knowledge all livestock for which
compensation is claimed was destroyed by wolf.
AG-00706
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651-201-6000.
TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
1/14/22 Page 1 of 2
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155-2538
WWW.MDA.STATE.MN.US
Plant Protection, Ph: 651-201-6020, MN_MDA_elkandwolf@state.mn.us
Minn. Stat. 3.737, MN Rules Chapter 1515
Compensation Claim for Livestock Destroyed by Wolf
($100 minimum, $20,000 maximum, claim per livestock owner per fiscal year)
Claim #_____________________
Claimant Information (fill out completely)
Investigator Information
Entity Name (Print)
Investigator Name and Title (Print and fill out completely)
Mailing Address
Phone
Date of Complaint
City
State
Zip
Type of Complaint
Phone
Email
Contacted by
County Where Depredation Occurred
UTM Coordinate of Property
Or →
Legal Description of Depredation Site
E
N
T
R
S
Was the livestock covered by insurance?
YES
NO
if yes, policy #
Amount $
____________________________________
________________
Insurance Agent Name
Phone
Have you received compensation for this loss from any other source?
Yes
No
if yes, Amount $
_____________
Evidence Leading Claimant to Believe the Livestock was Destroyed by Wolf
If this is the first claim you have filed, or the first claim in several years, you will need to submit a W9 in order for payment to be made.
Signature, Livestock Owner / Date _________________________________________________________________________
I certify that the information included on this claim is true and accurate; and to the best of my knowledge all livestock for which
compensation is claimed was destroyed by wolf.
AG-00706
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651-201-6000.
TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
1/14/22 Page 1 of 2
Determination of Livestock Loss and Compensation Award to be Completed by Investigator
List each animal confirmed as lost to wolves individually when practical. If it is not practical to list them separately, then indicate the number lost in that column.
Registered
Total Fair Market Value Determined
Number
Species
Description of Livestock
Age
Weight
Purebred?
(By County Extension Educator)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No 1. Was the carcass(es) or injured livestock for which compensation is claimed seen
The above calculated actual fair market
by investigator and do such remains appear to be consistent with the
value for the described livestock is accurate.
claims made?
Signature, Extension Educator
Yes
No 2. Is there evidence at the site that the livestock was killed?
Yes
No 3. Was the loss reported to an investigator within 48 hours of discovery?
Yes
No 4. Was usda wildlife services (218-327-3350) notified within 48 hours that an
Date
investigation was initiated.
Factors to consider in the investigation:
Yes
No
Unsure a. Wolf tracks and/or scat present.
Yes
No
Unsure b. Marks or wounds consistent with a wolf attack.
Printed Name
Yes
No
Unsure c. Bones or other physical remains, if present, appear to be or an age
consistent with time depredation occurred.
Date
Was the loss of livestocks likely caused by wolf?
Yes
Claim Recommended for Payment the above described loss occurred and the evidence
indicates the livestock was likely killed or injured by a wolf/wolves.
No
Claim NOT Recommended for Payment because:
Submit this Form to:
Minnesota Department of Agriculture
Animal Damage Claims
625 Robert St. N.
St. Paul, MN 55155-2538
Signature of Investigator / Date ________________________________________________________
To be Completed by the Minnesota Department of Agriculture:
Vendor #
Loc #
PO#
PO Line
Approved for Payment
Claim Total $
Less Insurance/Other Compensation $
TOTAL Claim Reimbursement $
Authorizing Signature / Date ________________________________________________________
AG-00706
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651-201-6000.
TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
1/14/22 Page 2 of 2
Page of 2