Salvage Permit - Virginia Department of Game and Inland Fisheries

□ Birds:(A US Fish & Wildlife Service Salvage Permit is also required)□ Fish:□ Freshwater Mussels:□ Macroinvertebrate Water Quality Sampling (NO ID for genus/species):□ Mammals:□ Furbearer:□ Small Mammals:□ Game:□ Marine:□ Other Aquatic Invertebrates:□ Other Terrestrial Invertebrates:□ Reptiles:County Name(s):Water Body(ies):Sub-Permittees/Field Collectors:Name:Affiliation:Name:Affiliation:Name:Affiliation:Name:Affiliation:Name:Affiliation:(If you have more than five subpermittees, please provide a separate sheet)Have you been convicted of violating any federal or state wildlife laws or wildlife-related regulations within thepast 5 years?Yes No If “yes,” Year and nature of offense:"I CERTIFY UNDER PENALTY OF LAW THAT THE INFORMATION SUBMITTED IN THISAPPLICATION IS, TO THE BEST OF MY KNOWLEDGE, TRUE, ACCURATE, AND COMPLETE. IALSO AGREE TO THE PERMIT CONDITIONS PROVIDED WITH THIS APPLICATION AND TO ANY2/27/2014 SAD