Loa Landowner'S Authorization To Manage Wildlife Or Exotic Animals By Aircraft

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Authorization

Department Use Only

Dept. Use Only

LOA

LOA Number:

Landowner's

Authorization to

L.E. Region:

Manage Wildlife or

County:

Exotic Animals by

Effective Date:

Aircraft

Stamp

Expiration Date:

Use Black Ink

Print or Type

Use Black Ink

Landowner's Name

Authorized Agent

(If other than Landowner)

Address

City

State

Zip

City

State

Zip

Telephone:

FAX:

Telephone:

FAX:

(

)

(

)

(

)

(

)

Farm/Ranch Name:

Total Acres:

Located in County(ies):

Physical Address:

City:

Zip:

Nearest Town:

Direction from Town:

Miles from Town:

On Hwy/Rd.:

Nearest Intersection:

GPS Coordinates:

Latitude:

Longitude:

Management of wildlife or exotic animals is necessary to administer or protect:

Land

Water

Wildlife

Livestock

Domestic Animals

Human Life

Crops

Mgt. Activity

Species

Count/Photo

Herd Only

Bobcats

Feral Hogs

List Exotics

Take

Coyotes

Red Fox

Coyote/Dog Crosses

Capture*

*Capture of game animals requires additional permits. Identify associated permit.

DMP

TTT/TTP

SPR

Permittee Name:

Permit Number:

I hereby consent to flights, only for the management of wildlife and exotic animals, over the above described property by authorized

aircraft listed under permit issued to:

Name of Aerial Permit Holder

Permit Number

(

)

(

)

Telephone Number

FAX Number

I understand that the above named wildlife or exotic animals are the only animals that may be managed, as stated in the activity column above, and

that this authorization shall be valid for the life of the aerial permit unless the permit expires without renewal, is suspended or revoked; or, if the

landowner or landowner's permit agent specifies a certain time period (noted above), the authorization shall be valid only during that period. If a

specific time period is requested for this LOA, please insert the beginning and ending dates for authorized flights:

Beginning Date, if Applicable

Ending Date, if Applicable

Signature of Aerial Permit Holder

Signature of Landowner or Authorized Agent

Date of Aerial Permit Holder's Signature

Date of Landowner's or Agent's Signature

PWD 0353 – L0200 (10/06)