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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