Application for Nuisance Wildlife Control Operator (NWCO ...
Renewal and Report Form for Nuisance Wildlife Control Operator (NWCO) License
NWCO License type: Commercial NWCO License (Fee $250 – 2 years) A $250 Renewal Fee is Enclosed
Non-Commercial (Municipal employees only) No Charge
Part I: Applicant Information (Include name of business and use business address phone if applicable)
|1. Applicant Name: |
|Mailing Address: |
|City/Town: State: Zip Code: |
|Phone: E-mail: |
| |
|2. Resident Address (if different from above): |
|Mailing Address: |
|City/Town: State: Zip Code: |
| |
|3. NWCO Information: |
|NWCO Certificate # (same as NWCO license number): N |
|Do you wish to be included in our NWCO Directory for nuisance wildlife referrals in your town or area? |
|Yes No If yes, which town do you wish to be listed in? (List only one) |
|If you have previously been certified to trap beaver as a NWCO, do you wish to continue? Yes No |
|Have you ever been arrested for a fish or game violation? Yes No |
|If yes, please state nature and time of violation: |
|4. In the year : |
|I was not active, so I am not submitting a report or I was active and have included my report forms |
Part II: Certification
|Any person making a written false statement on this form shall be subject to arrest as provided in Section 53A-157 of the Connecticut General |
|Statutes as amended. |
|“I declare, under penalties of false statement, that the submitted information and statement of my activities as a NWCO from December 1, _____ until |
|November 30, ____ is true, accurate and complete to the best of my knowledge and belief.” |
| | | |
| | | |
|Signature of Applicant | |Date |
Note: This Renewal and Report Form and a completed NWCO report must be submitted by December 31st of each year as a condition of the Connecticut General Statute section 26-47(b)(6). Failure to report on time may result in revocation of your license.
Renewals/Reports will be returned if all information requested is not provided. Prior to submitting this form, the following must be completed or included:
1. Complete and sign application (Must be 18 years or older to apply)
2. Include a $250.00 check or money order payable to CT DEEP if you are renewing your NWCO license (every two years) – Municipal employees are exempt from the licensing fee.
3. Submit the completed Renewal and Report form, Fee and Reports to: NWCO PROGRAM, WILDLIFE DIVISION, BUREAU OF NATURAL RESOURCES, DEPARTMENT OF ENERGY AND ENVIRONMENTAL PROTECTION, 79 ELM STREET, HARTFORD, CT 06106-5127
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