Application for Zoological Permit - Texas
Application for Zoological Permit
|1. Mr. Mrs. Ms. Dr. |Telephones |
|Applicant Name: | |Home: | |
|Profession Title: | |Office: | |
|Mailing Address: | |Cell: | |
| |Fax: | |
|City: | |State: | |Zip Code: | |Date of Birth: | |
|E-mail Address: | |Drivers’ License#/State: | |
| |1Social Security No.: | |
|2. Facility Name (business name): | |
|Facility (physical) Address: | |
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|City: | |State: | |Zip Code: | |County: | |
|3. Sub-permittees (Attach the name, driver’s license number/state, address and profession of assistants whom you desire to be named on your permit to work under |
|your supervision; please use the provided form). |
|4. Are zoo facilities currently open to the public? | No Yes |
| If no, Identify proposed opening date: | | | |
|5. Is this facility accredited by the American Zoo and Aquarium Association (AZA)? | No Yes |
|6. If facility is not accredited by AZA, are you prepared for an inspection to ascertain | No Yes |
|whether your facilities are in compliance with the standards set forth under Parks | |
|and Wildlife Regulations, §69.305? | |
|7. Do you anticipate receiving/possessing live potentially harmful fish species from | No Yes |
|individuals who hold Harmful Fish Permits? | |
|8. Do you propose to handle endangered species? | No Yes |
| If yes, identify what species: | | |
| | | |
|9. Identify your primary sources for acquisition of specimens: | |
| | Captured from the wild |
| | Transfer from existing permitted zoological facilities |
| | Purchased from game breeders, game bird breeders or fur-bearing propagator licensees/permittees |
| | Animals deemed non-releasable from licensed wildlife rehabilitators authorized to transfer such specimens |
| | Other: | |
|10. Identify which groups of animals you propose to possess and display: |
| mammals birds reptiles amphibians freshwater fish marine fish marine mammals |
1Texas Parks and Wildlife Department maintains the information collected through this form. With few exceptions, you are entitled to be informed about the information we collect. Under Sections 552.021 and 552.023 of the Texas Government Code, you are also entitled to receive and review the information. Under Section 559.004, you are also entitled to have this information corrected.
|11. Are you currently in possession of any protected wildlife? | No Yes |
|If yes, identify the species, quantity and source. | |
|Common Name | |Number of Specimens | |Source of Specimens |
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|12. Additional comments regarding proposed operation: | |
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|13. List any protected wildlife specimens you propose to hold for zoological purposes, along with the proposed quantities. |
|Common Name | |Scientific Name | |Number of Specimens |
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|14. List any federal permits you currently hold that pertain to federally protected species. | |
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|15. Have you ever been convicted of any violation of state or federal wildlife laws? | No Yes |
|If yes, explain. | |
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|16. Two Letters of Recommendation Enclosed (Required). |
|1st Letter from: | Current Zoological Permit Holder |or | Representative of AZA Accredited Facility |
|2nd Letter from: | Current Zoological Permit Holder |or | Representative of AZA Accredited Facility |
|17. $158.00 Permit Fee Enclosed (Required.) |
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|It is my intention to collect and/or display the approximate number of specimens of the species indicated above for the purpose(s) stated. I hereby declare that |
|the above statements made by me are true and correct to the best of my knowledge, and I understand that making a false statement on this application or in |
|subsequent annual reports is a crime punishable by fine and/or imprisonment. I will submit a written report indicating the number and species of specimens held |
|during the reporting period. This report shall be received by the Texas Parks and Wildlife Department’s Wildlife Permits Section within 14 das after my renewal |
|date each year. |
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|Applicant Signature: | |Date: | |
| |(Required) | |(Required) |
|NOTE: This application will not be considered unless fully completed. Falsifying information on this document is a punishable offense. Mail completed application|
|along with a check or money order to: |
|Wildlife Diversity Permits Section |
|Texas Parks and Wildlife Department |
|4200 Smith School Road |
|Austin, TX 78744 |
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