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Siee c.t Wigwam "PRING 1996
<br /> Department of Natural Resources
<br /> s 3 f
<br /> -REE AND SHRUB / �a'
<br /> APPLICATION n• .M,.,,,o,,,,:,,..*"..SsY r bun ■
<br /> .. �K. 7-
<br /> PLEASE READ INSTRUCTIONS ON PAGE I Form 2420 31 Stag
<br /> BEFORE COMPLETING THIS APPLICATION. Rev.�� '%` ;~ '" "
<br /> IMPORTANT: THIS SECTION MUST BE COMPLETELY FILLED OUT OR ORDER WILL BE RETURNED
<br /> (Please print)
<br /> Applicant's Last Name,First
<br /> PREFERRED METHOD OF DELIVER'
<br /> ELIVERY; (CHECK�/ONE)
<br /> I 1.42 049D Name,Fist D 44 1• Ship By QRNr<
<br /> Street or Route I (Check Page 4 to see if your county provides this County service.)
<br /> )
<br /> ❑ 2. I will pick-up at Griffith Nursery(Date)
<br /> City State Zip Code I O 3. I will pick-up at Hayward Nursery(Date)
<br /> I I LL-.I I l 1 1_ 1 I 4. I will pick-up at Wilson Nursery(Due)
<br /> Home Phone Number(include. code) Work Phone Number Go ra csods a cede) THIS STOCK SHALL BE PLANTED IN:
<br /> I (.of 1 PSS-/03: I I boV- I a5S-‘1644/ I County 'Section
<br /> 3 I Range
<br /> (Check d One) 'Township
<br /> CN.a y_ / 6
<br /> PAID ORDER ASSIGNMENT ORDER M pF/111 7 71gk7••a/64 74
<br /> msauceicn 9,page 1. FREE ORDER-Seedlings Only(order
<br /> 1. ❑ Private Order(100%remittance attach.) (2S�down payment required) prior to Jan. 15)
<br /> 2. ❑ County Forest S le CFSA Assignmeau,ACP 1 0 Registered School Forest or Community Forest
<br /> 3. ❑ Vo-Ag.,FFA,4-H and Youth Groups 6. Conservation Reserve(CRP) 2. ❑ DNR Lands(Fish.Wildlife,Parks)
<br /> d. ❑ Other State or Federal 7.❑ CFSA Asgigentent,,SIP 3• ❑ University of Wisconsin(Research)
<br /> 4. ❑ State Forest/sal
<br /> ae
<br /> Species or Packet- L
<br /> First Choice S / /Yl/f•A /0o ePS.5"pecies-2nd Choice Seedling Unit Price
<br /> (see instruction 3,page 1) (see instruction S,page 1) A A.e-Years 3
<br /> Pep O9E2 fAir D SI•f'�gs Number Wanted Total$$6900,46 139/Stip rteo S/i/t`�'' /31,46
<br /> Semis r,NF /If/503 yea /2/.ao
<br /> '/S, 1g41-.,k)M,r e t� 5��1I; jlCSc t$ I;i./S'cn 5/So fly.=o PEND DA/r
<br /> *2ylt /p•9..She `IOU 77445
<br /> IAA-017T: OAI4 Lot ter!: /call
<br /> Lill(rc RAe aY/� /;9/510 /Do aS.4O
<br /> .3',A. sp/seo boa G.9.f•t,
<br /> BC/t'Y, -,,r ,.lL- /v2 /a9/sec /oc
<br /> Su6Rn mop/s a 5.71b
<br /> um/re ceD,,r. 3.70t- afv/ , lda a9.ar�
<br /> 3 wt. So/t� .74e• ..71.70 NOR dA,) sPRut F
<br /> 8.,.,1_ Sr,/Soo `F02) `f/.Go
<br /> SUB-TOTAL if r 41 SD 977,10
<br /> ADD 5%SALES TAX
<br /> (see instruction 7,page 1) y F`j
<br /> TOTAL t ocno.,bq
<br /> (see instructions 8-9,page 1)
<br /> L(,`j5e)
<br /> AGREEMENT-PLEASE READ CAREFULLY
<br /> As applicant I agree:
<br /> I. Not to sell or give away this stock;I'm aware that violation of this clause is
<br /> W .Stats. punishable by a forfeiture of not more than S100 as provided in s.28.06,
<br /> 2. That this stock will not be used for decorative,ornamental,
<br /> landscaping purposes or Christmas trees and am aware that violation of this clause is
<br /> punishable by a forfeiture of not more than$500 as provided in s.28.06,Wis.Stats.
<br /> 3. Not to harvest or remove trees after planting until they are large enough to be sold or utilized as cut merchantable forest
<br /> Pn�mercial No trees may be products.or as an approved
<br /> �i• y removed from a plantation with roots attached for resale.
<br /> 4. To protect the area planted from fire and grazing.
<br /> 5. That a claim for adjustment regarding shortages or quality of stock must be made within ten days of delivery with the local DNR forester.
<br /> 6. That cancellation of an order after March 1 will be at the discretion of the seller:
<br /> 7. That I am responsible for payment at the rates established by the Department.
<br /> 8. To comply with all the rules and statutes applicable to the obtaining,use,and disposition of this forestry stock.
<br /> Sigm� x( Date Signed
<br /> //Ili&
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