Utah Division of

Wildlife Resources

Application for Reptile Collection Certificate of Registration

Applications must be received through mail, email, or in person at the DWR Salt Lake Office Only by January 19, 2018 5:00 pm. Utah Division of Wildlife Resources, ATTN: Wildlife Registration Office, PO Box 146301; 1594 W North Temple, Ste. 2110; Salt Lake City, UT 84114-6301 or email [email protected].

There is a $10.00 non-refundable handling fee and must be included when submitting application. You may enclose a check or money order payable to DWR, pay in person at a Division Office or arrange to make a credit card payment over

• the phone. Please list your phone number here
• to arrange payment by phone. The

$75.00 Certificate of Registration fee will be collected from successful applicants upon approval.

If necessary, a drawing will be conducted for those species that have more applications than available permits on January 24. Remaining permits will be available January 25 on a first-come, first-served basis at the DWR Salt Lake Office.

Name________________________________ Phone_______________________ Email________________________

State________

• ZIP________________
• Address____________________________ City___________________

Date of Birth___________________________

Limit

• Total
• Collection

Season

• Species
• per
• Authorized County

Permits
County

California Kingsnake Smooth Greensnake
66
21

• Garfield, Kane, and San Juan
• March 1 - Oct 31

March 1 - Oct 31
Daggett, Duchesne, Salt Lake, Summit, Utah, Uintah, Wasatch, and Weber Beaver, Daggett, Garfield, Iron, Kane, Millard, Piute, Salt Lake, Summit, Tooele, Uintah, Wasatch, and Washington

• Utah Milksnake
• 6

6
11
March 1 - Oct 31 March 1 - Oct 31
Beaver, Garfield, Iron, Juab, Kane, Piute, Sevier, Utah, and Washington
Utah Mountain Kingsnake
Select one species below and the counties of choice for collection

Smooth Greensnake (Opheodrys vernalis)

1st County Choice

California Kingsnake (Lampropeltis getulacaliforniae)

1st County Choice
2nd County Choice
2nd County Choice

3rd County Choice
3rd County Choice

Utah Mountain Kingsnake (Lampropeltis pyromelana infralabialis)
Utah Milksnake (Lampropeltis triangulum taylori)

1st County Choice
1st County Choice 2nd County Choice 3rd County Choice
2nd County Choice 3rd County Choice

APPLICATION MUST BE SIGNED: All statements on this form are true and correct. I understand that if I subscribe to any false statement on this application, I am subject to criminal prosecution. I certify that I am eligible for the permit for which I have applied. I declare under penalty of perjury that I am qualified under all prevailing laws and statutes to purchase or possess this permit.

X

Date

Applicant Signature