Natural Heritage Data Release Form
Please fill out this form if you are requesting information for conservation purposes or habitat management and
you are a non-profit conservation group, government agency or are working with a government agency.
Our response to this request will be a list of rare species found at your site. If you need additional information,
please contact 508-389-6380. Requestor Information: Name: Organization: Address: City: Daytime Phone: Ext.: State: Zip Code:
If a private individual working with a Non-Profit or Government Agency, enter organization information below: Organization Name:
Contact Person:
Address:
City:
Ext: State:
Zip Code:
Daytime Phone: Site Information: Name of Landowner (if different from above): Location:
USGS Quad Map:
Description of habitat management or conservation project (If necessary, attach additional sheet)
Have you enclosed the required copy of a USGS topographic map at the scale of 1:24,000 or 1:25,000 (not copy reduced) with the site location clearly marked and centered on the copy page? Please mail the completed form and topographic map to: Natural Heritage Data Release Natural Heritage & Endangered Species Program MA Division of Fisheries and Wildlife North Drive, Rte. 135 Westborough, MA 01581 Or fax to: (508) 389-7891 Natural Heritage Program Attn: Data Release
Questions regarding this request should be directed to (508) 389-6380.
Updated 7/05