New Hampshire Fish and Game Department
11 Hazen Drive, Concord, NH 03301
APPLICATION FOR SCIENTIFIC LICENSE
Fee: $25.00 - Waivers of the fee specified in RSA 214:29 shall only be granted to educational and nonprofit institutions and governmental
agencies.
1. Name:
2. Date
3. Affiliation or Company Name:
4. Mailing Address:
5. Telephone #:
6. Fax #:
7. E-mail:
8. Purpose of study:
9. Method of collection:
10. Dates of collection:
11. Waterbody or specific location(s) of collection:
12. Specific target species of wildlife to be taken and/or possessed:
13. Number of target species to be taken and/or possessed:
14. Final disposition of specimens collected:
15. Name(s) of person(s) to be listed as subpermittee(s):
16. Copies of this permit shall be carried by permittee or subpermittees while engaged in the activities permitted under
the scientific license.
17. This permit expires on December 31 of year issued. An annual report of specimens collected is required (see
reverse side).
18. Signature of Applicant:
FOR OFFICE USE ONLY
Approved by:
Inland Fisheries Div.
Executive Director
SPECIAL PERMIT CONDITIONS:
cc:
Division
Wildlife Div.
Date Issued
Marine Div.
Permit Number
REPORTING REQUIREMENTS
The licensee shall submit a report of study results by January 31 for period covered by the scientific permit to include the
following information:
(1) The name and address to which the scientific permit was issued;
(2) The purpose and objective of the study;
(3) Species and number wildlife taken;
(4) Age and sex, if known, of wildlife taken;
(5) Location(s) where species were taken or collected, including a map for those wildlife species tracked under
this license;
(6) Date received or collected;
(7) Disposition of the wildlife; and
(8) Location where specimens are held, if applicable.
cc:
Division