This report with progress reports and/or final reports must be submitted to the Texas Parks and Wildlife Department, Wildlife Diversity Permits Section, 4200 Smith School Road, Austin, Texas 78744 within 14 days following the expiration date shown on the permit. If you are requesting renewal, you must enclose the required non-refundable $53 application fee (unless you have already submitted a valid fee exemption form). Your permit will not be considered for renewal prior to the receipt of this report and any required fees.
This report must be signed and dated.
Permittee: / Report Date: / / / through / /
Month/Day/Year / Month/Day/Year
Street Address: / Permit Number:
Office Telephone Number:
City: / State: / Zip: / Fax Number:
1 Social Security Number: / E-mail Address:
1. Do you wish to discontinue this permit for any reason? / No / Yes
Reason for discontinuation:
2. Is your permit due to be renewed (see expiration date)? / No / Yes
If yes, have you enclosed the $53.00 renewal fee? / No (I am exempt) / Yes
(If exempt, exemption form PWD-0381B must be attached or on file with TPWD permitting office.)
3. Are you requesting any amendments or revisions to your current permit? / No / Yes
(If yes, please attach itemized list of changes being requested; attach new research proposal for any new research.)
4. Did you collect, possess, receive or salvage any state listed threatened or endangered species? / No / Yes
5. Did you collect, possess, receive or salvage any federally listed threatened or endangered species? / No / Yes
6. Did you collect, possess, receive or salvage any migratory birds? / No / Yes
7. Do you hold any federal permits? (If yes, please list below.) / No / Yes
8. Did you band, collect, possess, receive or salvage any species not authorized by your permit or in quantities greater than authorized? / No / Yes
9. Permit not used for reasons as follows:
10. Attach Species Collection Report (PWD 1051B) and any additional documentation (i.e., revision requests, copy of federal permits, exemption form, etc.).
11. Permittee Signature: / Date:
(Annual Report and Collection Report must be signed and dated.)
1 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 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.
PWD 1051 – W7000 (09/09)
/ Species Collection ReportPermittee's Name: / Permit Number:
Common Name/Scientific Name / Date of Collection / County/Location Collected / # Caught & Released / # Collected (live take) / # Salvaged / # Incidental Mortalities / Disposition of Specimens
Signature of Permittee: / Date:
Please attach list of recipients of all donated specimens. Collection Report must be signed and dated.
PWD 1051B – W7000 (09/09)