THREE MONTHLY RETURN OF PROTECTED FLORA

COMMERCIAL PURPOSES/COMMERCIAL PRODUCER'S LICENCES

- For Eucalypt mallee stems harvested for Didgeridoo purposes only

LICENSEE DETAILS:

Surname: / Other Names: / Licence Number:

DETAILS OF FLORA HARVESTED:Please refer to the explanatory notes on the reverse for further details. Unsatisfactory completion will not be accepted, and any requests for renewals of licences will be delayed until returns are supplied complete and correct.

Date
CP: of harvest
PN: of sale
Refer to note 6 / Genus
(eg. Eucalyptus) / Species
(eg. celastroides) / No. of stems / Tag No.’s
Refer to note 7 / Land Where Flora Harvested
Refer to note 8 / Locality Grid No.
Refer to note 9 / Name of Buyer/Dealer
(For individuals record as “Individual buyer”) / Buyer/Dealer’s Address
(NA for individual buyers)
MONTH: YEAR: .
MONTH: YEAR: .
MONTH: YEAR: .

LICENSEE’S DECLARATION:

I certify that the information on this return form is correct to the best of my knowledge. / SUBMIT FORM TO / Wildlife Licensing
Department of Parks and Wildlife
Locked Bag 30
Bentley Delivery Centre WA 6983
Signature: / Date:

EXPLANATORY NOTES:

  1. These returns are to be used for three (3) months at a time, hence only four (4) of these returns are required for the year of the licence. They must be submitted to DPaW’s Wildlife Licensing section by the 15th day of the month following the three (3) month period to which they relate.
  1. Please print clearly and legibly - USE BLOCK LETTERS.
  1. If there is insufficient space in any month for your return information, carry on into the next month's space, and attach another form if required.
  1. If no flora is taken in any month, a nil return for that month must be submitted.
  1. When filling in Licence Number, include the letters before the numbers as this is the whole licence number.
  1. Under the heading Dateyou must indicate the date of the harvest for Commercial Purposes (CP) Licences, or the date of sale for Commercial Producer’s (PN) Licences.
  1. Under the heading Tag No.’srecord for each entry the DPaW issued tag numbers that you attached to these stems
  1. Under the heading Land Where Flora Harvested you must provide details of the land where the flora for the entry was harvested. For Commercial Purposes (CP) Licences, this includes details of the Crown land, for example: name of Pastoral Station, name of Forest Block, writing ‘UCL’ and indicating the Shire/LGA, writing the name of the reserve/location (eg. Forest Road) and indicating the Shire/LGA. For Commercial Producer’s (PN) Licences, this includes details of the Private Property, for example: Lot/Location # and Shire/LGA.
  1. To complete the column Locality Grid No. use the ‘Grid Locality Map for Western Australia’(below) to determine the area that the flora has been taken from.
  1. Under the heading Name of Buyer/Dealer state the name of the company or person who purchased the flora. If the purchaser was an individual buyer please state “individual buyer”. Then in the column Buyer/Dealer’s Address detail the address of the company or person that was stated in the previous column. If the purchaser was an individual buyer their address is not required.
  1. Examples of filling out the form:

MONTH: December YEAR: 2012 .
9/12/2012 / EUCALYPTUS / CELASTROIDES / 4 / 1234-1237 / UCL, SHIRE OF KALGOORLIE-BOULDER / 175 / INDIVIDUAL BUYER / NA
20/12/2012 / EUCALYPTUS / CELASTROIDES / 10 / 1239-1248 / FLORA PASTORAL STATION / 155 / THE TREE CO. / 48 FLORA LANE, WANNEROO WA

12. Further information can be obtained from DPaW’s WildlifeLicensing sectionon phone (08) 9219 9836, fax (08) 9219 0242 or email:

GRID MAP LOCALITY FOR WESTERN AUSTRALIA:(refer to note 9, above)