8100-FM-FR0034 Rev. 1/11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
WILD PLANT MANAGEMENT PERMIT APPLICATION
I hereby apply for a Pennsylvania Wild Plant Management Permit to remove, collect or transplant wild plants
classified as PA Endangered or PA Threatened as listed within 17 Pa. Code Chapter 45, “The Conservation of
Pennsylvania Native Wild Plants.” Enclosed is a check for $5.00, payable to the “Commonwealth of PA.” for the
Wild Plant Management Permit.
NAME OF APPLICANT ____________________________________________________________
COMPANY (IF APPLICABLE)________________________________________________________
ADDRESS _________________________________________________ PHONE _______________________
__________________________________________________
E MAIL____________________________________________
PREVIOUS WILD PLANT MANAGEMENT PERMIT NUMBERS_______________________________________________
HAVE YOU EVER HAD A WILD PLANT MANAGEMENT PERMIT REVOKED? IF YES, LIST PERMIT NUMBER(S) AND
EXPLAIN______________________________________________________________________________________
MAY WE ADD YOUR NAME ON THE WILD PLANT MANAGEMENT WEBSITE AS SOMEONE WHO COULD BE CONTACTED TO
CONDUCT A PLANT SURVEY?
YES___________ NO_____________
**THIS APPLIES TO FUTURE LISTS DEVELOPED BY DCNR, NOT TO LISTS MAINTAINED BY CARNEGIE MUSEUM.
IF VOUCHER SPECIMENS ARE NECESSARY TO AID IN FURTHER IDENTIFICATION OF SPECIES FOUND ON SITE OR TO
DOCUMENT A NEWLY DISCOVERED POPULATION, THE APPLICANT AGREES TO FOLLOW THE VOUCHER SPECIMEN
COLLECTION PROCEDURES SET FORTH BY DCNR.
INITIAL HERE_________
THE APPLICANT UNDERSTANDS THAT ANY LOCATION AND HABITAT INFORMATION REGARDING ANY PA PLANT
SPECIES OF SPECIAL CONCERN (SOSC) FOUND ON SITE (WHETHER DCNR SURVEY REQUEST TARGET SPECIES OR NOT)
MUST BE REPORTED TO DCNR AND/OR THE PA NATURAL HERITAGE PROGRAM. A LIST OF ALL PA PLANT SPECIES
OF CONCERN CAN BE FOUND AT http://www.naturalheritage.state.pa.us/PlantsPage.aspx
INITIAL HERE__________
ALL APPLICATION INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.
SIGNATURE OF APPLICANT____________________________________________D ATE______________________
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8100-FM-FR0034 Rev. 1/11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
WILD PLANT MANAGEMENT PERMIT APPLICATION
ANNUAL RENEWAL FORM
NAME____________________________________
PREVIOUS PERMIT NO.________________________
* PLEASE SUBMIT THE WILD PLANT MANAGEMENT PERMIT APPLICATION COVER PAGE ALONG WITH THIS ANNUAL
RENEWAL FORM TO HELP EXPEDITE THE RENEWAL OF YOUR WILD PLANT MANAGEMENT PERMIT. PLEASE ATTACH
ADDITIONAL SHEETS IF NECESSARY.
PLEASE INDICATE WORKSHOPS, TRAINING PROGRAMS OR FIELD WORK (PNDI SURVEYS CAN BE LISTED BELOW) THAT
YOU HAVE COMPLETED IN THE PAST YEAR THAT STRENGTHENS YOUR QUALIFICATIONS AND/OR KNOWLEDGE
REGARDING OF PA PLANT SPECIES OF SPECIAL CONCERN (SOSC).
HAVE THE NAMES OR CONTACT INFORMATION OF THREE PEOPLE WHOM CAN ATTEST TO YOUR BOTANICAL SKILLS AND
EXPERIENCE WITH THE FLORA OF PENNSYLVANIA CHANGED SINCE YOUR LAST APPLICATION WAS REVIEWED?
PLEASE LIST ALL SURVEYS THAT WERE CONDUCTED IN RESPONSE TO A BOTANICAL SURVEY REQUEST BY DCNR (OR
RESEARCH CONDUCTED) TO EVALUATE IMPACTS TO PA PLANT SPECIES OF SPECIAL CONCERN SINCE YOUR LAST
PERMIT APPLICATION WAS REVIEWED (ATTACH ADDITIONAL SHEETS IF NECESSARY). PLEASE INCLUDE THE DATE,
COUNTY, SPECIES, PNDI NUMBER(S) AND OUTCOME OF THE SURVEY (SPECIES FOUND, UNSUCCESSFUL SURVEY, ETC).
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8100-FM-FR0034 Rev. 1/11
PLEASE NOTE ANY AVOIDANCE OR CONSERVATION MEASURES THAT WERE SUGGESTED AND/OR IMPLEMENTED. WAS
MONITORING REQUIRED FOR ANY PROJECTS (PLEASE LIST APPLICABLE PNDI NUMBERS)?
PLEASE NOTE ANY VOUCHER SPECIMENS THAT HAVE BEEN SUBMITTED IN THE PAST YEAR AND TO WHICH HERBARIA
THEY WERE SUBMITTED.
DISCLAIMER: THIS WILD PLANT MANAGEMENT PERMIT IS NON-TRANSFERABLE. PERMIT HOLDERS ARE REQUIRED
TO BE IN THE FIELD DURING ALL BOTANICAL SURVEYS FOR PA P LANT SPECIES OF SPECIAL CONCERN. PERMITS WILL
BE GRANTED TO INDIVIDUALS ONLY AND WILL NOT BE GRANTED TO COMPANIES OR ORGANIZATIONS. ANY APPLICANT
WHO IS DENIED A WILD PLANT MANAGEMENT PERMIT RESERVES THE RIGHT TO APPEAL THIS DECISION. DCNR MAY
REVOKE A WILD PLANT PERMIT FOR A GOOD CAUSE, INCLUDING BUT NOT LIMITED TO FAILURE TO COMPLY WITH A
TERM OR CONDITION OF THEIR PERMIT, OR CHANGES IN THE CIRCUMSTANCES DESCRIBED IN THE APPLICATION FOR THE
PERMIT, WHICH INDICATE THAT THE ACTIVITY NO LONGER IS IN THE BEST INTERESTS OF PENNSYLVANIA WILD PLANT
MANAGEMENT. A PERSON WHOSE PERMIT HAS BEEN REVOKED IS NOT ELIGIBLE TO APPLY FOR OR OBTAIN ANOTHER
WILD PLANT MANAGEMENT PERMIT FOR 2 YEARS FROM THE DATE OF REVOCATION. WILD PLANT MANAGEMENT
REGULATIONS CAN BE VIEWED AT : http://www.pacode.com/secure/data/017/chapter45/chap45toc.html
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