Tpwd Landowner Permission For Wildlife Research And Investigation
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1LANDOWNER PERMISSION FOR
LANDOWNER PERMISSION FOR
WILDLIFE RESEARCH AND INVESTIGATION
WILDLIFE RESEARCH AND INVESTIGATION
(Pursuant to Section 12.103 of the Texas Parks and Wildlife Code)
(Pursuant to Section 12.103 of the Texas Parks and Wildlife Code)
By my signature below, I hereby authorize Texas Parks and Wildlife Department (Department)
By my signature below, I hereby authorize Texas Parks and Wildlife Department (Department)
employees, or persons working on behalf of the Department, to enter private property I own or
employees, or persons working on behalf of the Department, to enter private property I own or
manage for the purpose of conducting scientific research and investigation regarding wildlife and
manage for the purpose of conducting scientific research and investigation regarding wildlife and
natural resources, to record and use site specific information from the property for scientific research
natural resources, to record and use site specific information from the property for scientific research
and investigation, and to allow public access to the information to the degree authorized below.
and investigation, and to allow public access to the information to the degree authorized below.
(Authorized scientific research, investigation, or activity)
(Authorized scientific research, investigation, or activity)
Release of Information (Location Specific)
Release of Information (Location Specific): I hereby further authorize the Department to store the
information collected in publicly available Department databases and use the information in
Department reports, maps, publications, environmental project reviews, or otherwise make the
information available to the public in a manner that identifies the specific location of the private
property I own or manage.
_______________________________________
_____________________
(Landowner or authorized agent)
(Date)
OR
Release of Information (Non-Location Specific): I hereby further authorize the Department to
store the information collected in publicly available Department databases and use the information in
Department reports, maps, publications, or otherwise make the information available to the public
only in a manner that is generalized to a level that does not identify the specific location of private
property I own or manage.
________________________________________
_____________________
(Landowner or authorized agent)
(Date)
Name and Address:
(Please print legibly)
___________________________________________________________________
(Name of Landowner or Authorized Agent)
_____________________________________________________________________________________________________
(Property, Ranch, or Tract name)
_____________________________________________________________________________________________________
(Address)
_____________________________________________________________________________________________________
(City, State, Zip)
___________________
_____________________
_____________________
(Home Phone)
(Office Phone) optional
(FAX) optional
___________________________________________________________________
(Email Address) optional
Texas 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 553.023 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. For
assistance call 512-389-4978.
PWD 0153A – W7000 (03/11)
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