Taxidermist permit record document

No.

Section 1: Taxidermist

Taxidermist (full legal name):
Taxidermist Permit Number:
Date bird(s) /egg(s) received by taxidermist: (Year/Month/Day)

I hereby confirm that all information contained on this record sheet is accurate to the best of my knowledge.

Taxidermist signature:

Section 2: Owner

Owner (full legal name):
Owner phone number:
Owner mailing address:
Owner email address:
Federal permit type:
Federal permit number^{Footnote 1} :
Migratory bird species:
Number of birds:
Number of eggs:
Date(s) killed/obtained (YYYY/MM/DD):
Place(s) killed/obtained:
Circumstances of killing(s):

I hereby confirm that all information contained on this record sheet is accurate to the best of my knowledge.

Owner signature:

Note: This form must be completed and signed unless the specimens are accompanied by a signed statement including the above information  

Section 3: Customer (fill out if customer is not the owner)

Name (full legal name):
Mailing Address:
Email address:
Phone number:
Written statement signed by owner is attached [Checkbox]

I hereby confirm that all information contained on this record sheet is accurate to the best of my knowledge.

Customer signature:

Section 4: Completion of transaction

Date migratory bird(s)/egg(s) returned to owner/customer: (Year/Month/Day)

Enforcement/Inspection - Officer use only:

Name (full name):  
Date:
Affiliation (ECCC, RCMP, Province/Territory):
Signature: