Form Center

2. OWNER INFORMATION
4. Owner’s Legal Name*
5. Date Ownership Effective*
7. Legal Description of Property*
8. Phone Number of Owner or Agent*
12. PROGRESS REPORT – WILDLIFE SPECIES
14. Describe management actions, events or developments taken in the prior year that affect wildlife species and/or habitat*
18. PROGRESS REPORT – NOXIOUS WEEDS
20. Please describe actions taken to implement the noxious weed management plan and any departures from the plan*
22. Describe actions to control noxious weeds and status of infestation by species*
24. **Please submit with Annual Wildlife Habitat Exemption application
28. I certify the information provided herein is a true description of the action taken last year to manage the land under the terms of the noxious weed management plan and conservation easement/agreement or wildlife management plan.
30. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I Agree
    2. I Do Not Agree
32. Signature*
33. Date*
    Date
35. Title*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field