Section 1590

Section 1590.APPENDIX A Migratory Bird Acquisition and Disposition Report

UNITED STATES DEPARTMENT OF THE INTERIOR

Fish and Wildlife Service

MIGRATORY BIRD ACQUISITION AND DISPOSITION

________________________________________________________________________

TRANSFER

Name:

FWS Permit No:

Address:

City:

State:

Zip:

Species:

Band No:

Age:

Nestling

Adult

Year of Hatch

Sex:

Male

Female

Unknown

Type of Disposition:

Release

Escape

Theft

Date:

Death

Gift

Sale

Loan

ACQUIRE

Name:

FWS Permit No.

Address:

City:

State:

Zip:

Species:

Band No:

Age:

Nestling

Adult

Year of Hatch

Sex:

Male

Female

Unknown

Type of Acquisition:

Wild-Caught

Purchase

Gift

Loan

Date:

BANDING

	If this form reports the acquisition of a bird from the wild, the person who bands
3	the bird must complete the information below:
	Band Number:	Band Type:

I certify that the above statements are true and correct to the best of my knowledge. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001.

Signature:

Date

NOTE: Each individual fully completes a separate form

TRANSFER (PART 1) Transferor completes parts 1 and 2, retains white copy, and sends original and colored copies to U.S. Fish and Wildlife Service Regional Law Office which has responsibility for the State in which the permittee is located.

ACQUIRE (PART 2) Person acquiring bird completes part 2 and (part 1 or 3, if applicable), retains white copy, and sends original and colored copies to the U.S. Fish and Wildlife Service Regional Law Enforcement Office which has responsibility for the State in which the permittee is located.

BANDING (PART 3) Person banding the bird completes this part and parts 1 and/or 2 if bander transfers or acquires the bird, retains the white copy, and sends original and colored copies to the U.S. Fish and Wildlife Service Regional Law Enforcement Office which has responsibility for the State in which the permitted activity takes place.

AREAS OF RESPONSIBILITY AND OFFICE ADDRESSES

California, Hawaii, Idaho, Nevada, Oregon, Washington, American Samoa, Guam, the Marshall Islands, Northern Mariana Islands, and the Trust Territory of the Pacific Islands (District 1): 1002 N.E. Holladay St., Portland, OR 97232-4181, Telephone 503-231-6125

Arizona, New Mexico, Oklahoma and Texas (District 2): P.O. Box 329, Albuquerque, NM 87103, Telephone 505-766-2091

Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio and Wisconsin (District 3): P.O. Box 45, Twin Cities, MN 55111, Telephone: 612-725-3530

Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Puerto Rico, and the Virgin Islands (District 4): P.O. Box 4839, Atlanta, GA 30302, Telephone 404-331-5872

Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia and West Virginia (District 5) P.O. Box 129, New Town Branch, Boston, MA 02258, Telephone 617-965-2298

Colorado, Kansas, Montana, Nebraska, North Dakota, South Dakota, Utah and Wyoming (District 6): P.O. Box 25486, Denver Federal Center, Denver, CO 80225, Telephone 303-236-7540

Alaska (District 7): P.O. Box 92597, Anchorage, AK 99509-2597, Telephone 907-786-3311

Any foreign country (Washington Office): P.O. Box 3247, Arlington, VA 22203-3247, Telephone 703-358-1949

Migratory Bird Acquisition and Disposition Report

NOTICE:

In accordance with the Privacy Act of 1974 (Pub. L 93-579) and the Paperwork Reduction Act (Pub. L 96-511), please be advised that

1. The gathering of information on fish and wildlife is authorized by:

(a) Migratory Bird Treaty Act (16 U.S.C. 703-712)

(b) Part 13 of Title 50 of the Code of Federal Regulations, and

2. The disclosure of the requested information is required in order to administer permits under the above Act. Response to this request is required to exercise benefits of a permit issued by the U.S. Fish and Wildlife Service. Failure to disclose all of the requested information may be sufficient cause for the U.S. Fish and Wildlife Service to suspend or revoke your permit.

3. In the event there is indicated a violation of a statute, regulation, rule, order, or license, whether civil, criminal, or regulatory in nature, the requested information may be transferred to the appropriate Federal, State, local or foreign agency charged with investigating or prosecuting such violations.

4. In the event of litigation involving the records or the subject matter of the records, the requested information may be transferred to the U.S. Department of Justice.

5. The requested information may be subject to disclosure under provisions of the Freedom of Information Act (5 U.S.C. 552)

6. Public reporting burden for this form is estimated to be 10 minutes per response including time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Service Information Collection Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 18th and C Streets, N.W., Washington, D.C. 20240, and the Office of Management and Budget, Paperwork Reduction Act Project (1018-0022), Washington, D.C. 20503.

(Source: Added at 14 Ill. Reg. 6088, effective April 17, 1990)