Florida Department of Agriculture and Consumer Services [pace sona portroqost and Division of Plant Industry cmespemsson tr REQUEST FOR PERMIT TO HARVEST ENDANGERED P.0. Box 147109, Gainesvile, ‘OR COMMERCIALLY EXPLOITED PLANT(S) OR Florida 32614-7100 NICOLE “NIKKI” FRIED PLANT PART(S) ‘COMMISSIONER Section 581.185, FS, / Rule 58-40.008, FAC. PO Box 147100, Gainesvile, Florda 326%4:7100-Phone: (352}395-4700 ‘THIS SECTION TO BE COMPLETED BY STATE OFFICIAL TT Approved 1 disapproved Botanist Signature Signature Additional Conditions Valid Until Title Date ‘THIS SECTION TO BE COMPLETED BY APPLICANT Isitisa Renewal ofa [ Name of aeney or person applying research Pei? Maing address: ve NT mail address Fee indicate peo umber Phone Name of person(s) authorized to collect unde this permit ‘Guanity oF percentage of plans oF plant Purpose (check al that apply) pats be Salvage Latin & Common Name Plant Part harvested Propagation | (rescue) | Sale| *Rescareh sesentchors please amach uma of reach proj i ational plat pies eed ob a pene ute page 3. he plants must be removed, harvested, wansporte, and stored in such a manner as ensue their survival hin port and writen permission rom the property owner must bein the possession ofthe permite when collecting and wen in posession of permit rdaered or commercially exploited plat species, hin pormit must be nthe possession of the permitce when tansprtng, sling, and ofeing fr sale, Brokers, dalr, and vendor permite forthe sale of endangered or commerctaly exploited pant species mst maintain copie of permis fom collector, We agree to comply withthe stipulations ofthis agreement, Section $81.211((b), Florida Statutes makes it fest dapree misdemeanor to forge, countret, disguise or improperly use any permit Signature of applicant: Date: FOACS-08025 Rev 05/19 Page 1 of 3PERMISSION LETTER FOR HARVESTING Required for all properties, including your own. Complete one permission letter per property; include permission letters for all properties to be harvested with request. Name of property owner: Name of person granted permission to harvest: Property owner mailing address: Property owner phone number: Physical address of property where harvesting will be allowed: OR, Parcel Number OR, Township. Range. Section, AND a description of property. OR, Latitude Longitude. AND a description of property. Please send permit request and permission letters to DPISPB@reshfromflorida.com or P.O. Box 147100, Property owner signature: Gainesville, Florida 32614-7100 Date: FDACS-08025 Rev 05/19 Page 20f3Latin & Common Name Plant Past Quantity or percentage of | plants or plant pats tobe harvested Purpose (check all that apply) Propagation Salvage (Geseue) Sale "Research Section $81.185(1) FS The Legislature nds and declares tha it shall be the public policy of his state to: provide recognition of those plant species ned, oF commercially expaied; protect the nalive fora fram unlawful harvesting on bath public and privately owned lands: provde an orderly and controlled procedure for restricted harvesting of native Nora from the wid, thus preventing wanton ‘exploitation or destruction of native plat populations; encourage the propagation of native species of fora: and provide the people of this slate with ‘he information necessary to legally harvest native plants s0 a8 to ultimately transplant those plants withthe greatest possible chance of survival hata tothe slate that are endang Page 3 of 3 DACS-08025 Rev 05/19 the