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SCIENTIFIC HOLDING 1
NJ DIVISION OF FISH AND WILDLIFE WILDLIFE PERMITS UNIT - EXOTIC AND NONGAME WILDLIFE PERMITS
SCIENTIFIC HOLDING
2008 RENEWAL APPLICATION - ANNUAL REPORT
COMPLETE APPLICATION - TYPE OR PRINT CLEARLY - ATTACH ADDITIONAL SHEETS IF NECESSARY. NO PERMIT
WILL BE ISSUED WITHOUT A COMPLETED APPLICATION AND CORRECT FEE.
ONLY USE THIS RENEWAL IF YOU HAVE BEEN ISSUED A PREVIOUS YEAR PERMIT. IF YOU HAVE
NOT BEEN ISSUED A PREVIOUS YEAR PERMIT, YOU MUST COMPLETE AN INITIAL APPLICATION,
WHICH IS ALSO AVAILABLE ON THE DIVISION'S WEBSITE: www.njfishandwildlife.com
PLEASE CIRCLE ONE:
RENEW THIS PERMIT DO NOT RENEW THIS PERMIT
IMPORTANT NOTE: An Annual Report is required even if you are not renewing. If you
are not renewing - DO NOT SUBMIT FEE.
SCIENTIFIC HOLDING PERMIT NUMBER
:
SH 27____________________
2007 Permit Number MUST BE SUPPLIED
NAME__________________________________________________________________________________
HOME ADDRESS ________________________________________________________________________
Street
________________________________________________________________________________________
City State Zip Code with Extension
NEW JERSEY COUNTY________________SCHEDULE: Days and Hours Open _____________________
Home Phone: (_____)________________________Work Phone: (_____) ____________________________
Fax Number: ___________________________ E-mail Address: ____________________________________
Website Address (if applicable):______________________________________________________________
SCHOOL OR INSTITUTION NAME: ________________________________________________________
(If applicable)
SCHOOL OR INSTITUTION ADDRESS______________________________________________________
MUST BE PROVIDED

Street
________________________________________________________________________________________
City State Zip Code with Extension
SCHOOL OR INSTITUTION NEW JERSEY COUNTY: __________________________________________
VETERINARIAN NAME __________________________________________________________________

Required
ADDRESS ______________________________________________________________________________
Street
____________________________________________________________________________________________________________________________________
City State Zip Code with Extension
VETERINARIAN PHONE: (_____) __________________________________________________________
Required 2
!
ATTACH PHOTOCOPIES OF CURRENT, APPLICABLE
PERMITS INCLUDING STATE PERMITS, USDA CLASS R
PERMITS, U.S. FISH & WILDLIFE SERVICE PERMITS, ETC.
YOUR PERMIT WILL NOT BE REVIEWED OR ISSUED UNTIL
THIS MANDATORY INFORMATION HAS BEEN SUPPLIED.
IMPORTANT: The following required information should support and justify the
renewal of this SCIENTIFIC HOLDING permit. Attach a summary of your activities,
findings and any applicable reports.
Describe in detail the SCIENTIFIC RESEARCH and/or EDUCATIONAL activities that you conducted
last year. List a minimum of six (if applicable) educational presentations that were conducted in the
previous year of issue. Please include group/organization name, contact name, address, phone number
and date.
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IMPORTANT NOTE: If any fees were received for these presentations,
contact the New Jersey Division of Fish and Wildlife, Wildlife Permits Unit,
Exotic and Nongame Species Section. The Scientific Holding Permit IS NOT
the appropriate permit category if fees are received. 3
LIST YOUR CURRENT INVENTORY, AS OF DECEMBER 31, OF REGULATED
EXOTIC & NONGAME SPECIES IN YOUR POSSESSION. Please use common names.
NUMBER SEX SPECIES BIRD BAND/MICRO-CHIP #
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IMPORTANT NOTE: NO POTENTIALLY DANGEROUS SPECIES OF ANY
KIND MAY BE OBTAINED WITHOUT PRIOR WRITTEN APPROVAL FROM
THE WILDLIFE PERMITS UNIT, EXOTIC AND NONGAME PERMITS
SECTION. Requests for approval must be in writing and include information on
the proposed origin of the animal, description of diet, caging, etc. [N.J.A.C. 7:25-
4.7, 4.8, & 4.9).
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If your COLLECTION OF REGULATED EXOTIC AND
NONGAME WILDLIFE SPECIES HAS CHANGED IN ANY WAY,
AS OF DECEMBER 31 OF THE PREVIOUS YEAR OF ISSUE you
MUST COMPLETE THE FOLLOWING SECTIONS.
NEW ADDITIONS TO YOUR COLLECTION
(For new species, thoroughly describe caging
facilities on a separate sheet)
NUMBER SEX SPECIES SOURCE OF ACQUISITION
(Name, Address, Date)
________________________________________________________________________________________
________________________________________________________________________________________
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BIRTHS
NUMBER SEX SPECIES DATE
________________________________________________________________________________________
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DEATHS
NUMBER SEX SPECIES CAUSE DATE
________________________________________________________________________________________
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TRANSFERS. NO POTENTIALLY DANGEROUS WILDLIFE SPECIES MAY BE
TRANSFERRED TO A NEW JERSEY RESIDENT.
RECIPIENT NAME SPECIES