Form 3-200-15b - Re-Order Request Eagle Parts For Native American Religious Purposes Page 4
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7Department of the Interior, U.S. Fish and Wildlife Service
OMB Control # 1018-0022
National Eagle Repository
Expires 02-28-2014
RMA, Building 128, 6550 Gateway Road
OFFICE USE ONLY
Commerce City, CO 80022-1798
Date Completed Request
(303) 287-2110
received in NER
_______/______/______
RE-ORDER REQUEST
E
P
N
A
R
P
AGLE
ARTS FOR
ATIVE
MERICAN
ELIGIOUS
URPOSES
Initials: _________
Please see reverse for instructions
Last Name
First Name
Middle Name
Suffix
(Sr., Jr., etc.)
Physical address (Street address; Apartment #, Suite #; no P.O. Boxes)
City
State
Zip code/Postal code
Mailing Address (if different than physical address)
City
State
Zip code/Postal code
Date of Birth
Social Security Number
Name of Contact Person (if you have no phone)
Home Phone Number
Work Phone Number
Phone Number of Contact
Permit Number
Cellular Phone Number
E-Mail Address
MB
DESCRIPTION OF REQUESTED MATERIAL
(You can only make one request at a time.)
(May not exceed parts of
Approximate
Item
Age
one whole eagle)
Waiting Period
Species
Adult
4 ½ - 5 years
Golden
Whole Carcass – Golden Eagle
Immature
2 - 2 ½ years
Bald
Whole Carcass – Bald Eagle
Either
Either
1 year
Pair of Whole Wings
See page 3 for examples
4 ½ - 5 years
Whole Tail – Golden Eagle
2 - 2 ½ years
Whole Tail – Bald Eagle
(Orders for immature
6 months
(Orders for golden
10 Quality Loose Feathers (8 wing; 2 tail)
golden eagles take the
eagles take longer
90 days
20 Miscellaneous Loose Feathers (lower
longest to fill.)
to fill than bald
quality mixed)
eagles.)
Pair of Talons
Minimal
Head
Minimal
Trunk (body without head, feet, wings or tail)
Minimal
N
Y
T
:
E
N
.
AME OF
OUR
RIBE
NROLLMENT
O
I hereby certify that I am requesting an eagle items for religious purposes and that the information submitted herein is complete
and accurate to the best of my knowledge. I understand that false statements made here may subject me to criminal penalties.
Signature:
Date: _______________________
===== OFFICE USE ONLY BELOW HERE ====
A
C
N
:
R
#___________
PPLICANT
ONTACT
OTE
EQUEST
Date of shipment to applicant:
/
/
Initials:
Form 3-200-15B (Rev 09/2010)
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