J. Christopher Ludwig
Virginia Department of Conservation and Recreation
Division of Natural Heritage
217 Governor St.
Richmond, VA 23219
Species Name (please include a photograph(s) if available): __________________________________ Date Observed: _____________________ County(ies):_____________________________________________________________ USGS Quadrangle Name(s) (if known): ______________________________________________________________ Location: (Provide a detailed description. Include a copy of a USGS topographic map showing the location or sketch a map on the back of this form)
Habitat Description: (Include associated species, elevation, natural features, natural community type, etc.)
Population Data: (Include data such as number of individuals, age, size, spatial distribution, evidence of reproduction)
Property Owner (name, address, phone if known): ____________________________________________________Threats or evidence of Disturbance:
Protection Information: (Under present conditions, will this population maintain itself over a long period of time? Why or why not?)
Contact Information: Reported By: _______________________________Address: Phone: E-Mail: Date:
