New Application Requesting Renewal or …

OMB Control No. 1018-0022 Expires 04/30/2021 Form 3-200-72 (Rev. 07/2019) Department of the Interior FEDERAL FISH AND WILDLIFE PERMIT Application FORM Eagle Nest Take (Bald and Golden Eagle Protection Act, 50 CFR ) Fish and Wildlife Service Division of Migratory Bird Management TYPE OF REQUEST New Application Renewal BEFORE FILLING OUT THIS FORM, please access the Return Addresses (to obtain the email/postal addresses where this form can be returned), review the Frequently Asked Questions, and read the form Instructions. Please retain the "NOTICES" page for your records. Amendment If Requesting a Renewal or amendment, provide Permit # Complete Sections A or B, and C, D, and E of this Application . address may be required in Section C, see instructions for details. See instruction page(s) for information on how to make your Application complete and help avoid unnecessary delays. A. Complete if applying as an individual Last First Middle name or Suffix2.

8. Provide the length of time for which the permit is requested, including beginning and ending dates. 9. When an in-use nest must be removed under this permit, any take of nestlings or eggs must be conducted by a Service-approved,

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