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<br />. . <br /> <br /> <br />DEPAIlD .DE INTERIOR <br />'.S. flSlABIUUfE SERVICE <br /> <br />. <br /> <br />fEIDJI.IISIAII WILDUFE <br />LJC(I$(flOWI APPUCA TlON <br /> <br />3. APPuCtrllllT. (II.... eM,'." ............._hr.1 i.d;y;"'. <br />...i..... .,.-:y. fH i..,i,."ioa,. riid,.,.;t.. .......MI <br /> <br />4. IF ..APfIIUCANro as AN IHOMIIIM. (DIIIIL.E'tt ntE ~u.owtHG: <br /> <br />- <br /> <br />WEIGHT <br /> <br />0..... 0-- 010'$$ OIlS. <br />DATEOF~ <br /> <br />...... COLOR ~ES <br /> <br />.PHONE .........:lEA: WHERE ENP\.OYED SICIM.. BIIIWn' NUMBER <br /> <br />OCQJPA TICIIt <br /> <br />ANY 8..IS&HESS. AGENCY. OR 1NSn1U'Dl:lMlL AfFIUATtON HAVING <br />TO DO WlTK THE WIl.OUFE 10 BECIMIIERID_lHIS UCENSE/PERIlUT <br /> <br />6. LOCAT1QoIMiERE: PAOPOSED ACTIWTYe.1E CONDUCTED <br /> <br />.. CERTIFIED CHECK OR tC)NE'I 0AIIIIt.~ PAVABLE TO <br />THE U.$. FISH AHD W,\..DL.IFE SElMCEBICLIIED IN AMOUNT OF <br /> <br />APPENDIX A <br /> <br />OMB NO. .u~RUi70 <br /> <br />I. APPUCATIOH F~ (lft";~'.." _oJ <br /> <br />o IMPORT OR EXPORT L1CEHSlE <br /> <br />o PEAiIlIT <br /> <br />Z. BRIEF DESCRIPTION OF Acnvfrv FOR WHiCH REOLj{STED LICENSE <br />OR PE:FNIT IS NEEDED. <br /> <br />L IF 'oAPPUCAHT" .S A BUSlN~ CORPORA TICH. PUBLIC AGENCY. <br />OR INSTITUTION. c:c;M>>UTE. tHE FOLLOWiNG: <br /> <br />EXPLAIN TYPE OR KIND Of' 8JSlNESS" .IGOICV. OR INSTITUTION <br /> <br />NAME. TITLE. AND PHONE N....BER OF PRESiDENT. PRINCIPAl. <br />OFFICER" DfRECTOR. ETC. <br /> <br />IF "APPLICANT'" ISA CORPORATION. INOtCATE STATE IN WHlQi <br />INCORPORATED <br /> <br />1. DO YOU HOLO AHY QJRRENT1.Y VAL.ID FEOERAL. FISH AHD <br />WIt..DUFE LICENSE OR PEFMn 0 YU 0 NO <br />(II ,... Ii., 'ie.... ... ,.,.if _....... <br /> <br />.. IF REQUIRED BY AHY STATE OR FOREIGN GOVERNMENT. 00 YOU <br />HAVE THEIR APPROVAL TO CClNDJCT THE ACTIVITY YOu <br />PROPOSET 0 YES 0 NO <br />(II ,.a. Ii., Juriadieliaa _~ rr,. ., 4oc...,,,, <br /> <br />10. DESIRED EFFECTIVE <br />GATE <br /> <br />II. OURATIOH HUDED <br /> <br />, <br /> <br />12. ATTAo.ENTS. THE SPEC1RC_ __MQU1RED FOR THE TYPE OF UCEHSElPE~IT REQUESTEDtS.. JO c;:,.,J.I2(.,JWST BE <br />ATTAOtED. aT COHSTITUTESM"--''''''' OF THIS APPLICATION. UST SECTIONS OF 50 CFR UNDER WHIOt ATTACHMENTS ARE <br /> <br />PROVlom. <br /> <br />CERTIFICATION <br /> <br />I HEREBY CERTIFY TltAT IIIAVE __.fAIIIUAR WITlt THE REGUunOHS COHTAIHED IN nTLE SO. PART n. Of THE CODE OF FEDERAL <br />REGUUTlOllS AlID THE OlHEl ArfUDIlfMn II SUIlOlAPTER B OF OlAPTER I OF TITLE SO, AHD I fURTltER CERTIFY TltA T TltE INFDR. <br />IIA nON SUBlllTTED IN THIS APrUCA__IUCEIlSElPERMIT IS COMPlETE AHD ACOJRA TE 10 THE BEST OF MY KNOWLEDGE AHD BELlEI'. <br />I UNDERSTAHD 1llA T ANT FALSE ~ _ MAY SUBJECT ME TO THE CRIMINAl PENAl nES Of 11 U.S.c. 1001. <br /> <br />StGNA TURE (1. Mil OA TE. <br /> <br />..- <br />t6.'7.. <br /> <br />.......,.... <br />