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Florida Fish & Wildlife Conservation Commission Landowner Assistance Program

Acknowledgement Form More than half of Florida's land area is held in private ownership. The Florida Fish and Wildlife Conservation Commission (FWC) recognizes the critical role that private lands play in providing sustainable wildlife populations and wildlife habitat. The FWC's Landowner Assistance Program (LAP) is a technical assistance program designed to help landowners maintain and enhance private working landscapes that benefit wildlife resources.

Landowner Contact Information: Please fill out all information clearly and accurately.

First and Last Name

Mailing Address

City State Zip

Code Home Phone Cell Phone

Email

Property Information: Please fill out all information clearly and accurately.

Farm/Ranch Name If Applicable County

Property address (if different from mailing address)

Property Street Address City Property City

Section (s) Township (s)

Indicate North or South

Range (s) Indicate East

or West Acres

Farm/Ranch Manager Name If Applicable Phone Manager's Phone

Select the type of technical assistance desired: Habitat Plan, Invasive Species, Landowner Conservation Associations, Wildlife, Wildlife Habitat Recognition Program, or Other. Describe Other Assistance Desired

Select the category(ies) of wildlife for which you are most interested in managing?

Game Non-game Threatened/Endangered

By signing this acknowledgement form, I make the following certification and agreements in favor of the FWC.

1. I certify that I am the legal owner of the land described on this acknowledgment form. 2. I certify that participation, by me or on my behalf with FWC's Landowner Assistance Program, is not

fraudulent or otherwise illegal. 3. FWC access to the property listed above will be obtained only with prior permission. 4. I authorize, do not authorize FWC to collect incidental observations of threatened and

endangered plant and animal species. Information collected will be used to guide management recommendations and fill critical data gaps regarding the state's wildlife resources.

5. I acknowledge that written technical guidance provided by FWC staff is subject to public records requests per Florida Public Records Law, Chapter 119 Florida Statutes.

6. Participation in the LAP is voluntary and receiving technical assistance is not contingent on your authorizing FWC to collect incidental observations. No observations of threatened or endangered species will be collected without your authorization in number 4 above.

Landowner Acceptance Date mm/dd/yyyy

Submit this request to: Tony Grossman Landowner Assistance Program Administrator 620 South Meridian Street MS 5B5 Tallahassee, FL 32399-1600 Anthony.Grossman@MyFWC.com Learn more at: MyFWC.com/LAP

Revised February 2019