Gallatin County Predation Incident Reporting Form

The Gallatin County Commission wishes to gather information on livestock predation within Gallatin County. This form will submit your report directly to the Gallatin Board of County Commissioners for information purposes only.

Reporter Name

Mr. Ms. Mrs. Dr.
Name First Last
Affiliation
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Phone - (###) - ### ####
Email

Incident Data

Incident Type Attack Only Attack and Loss
Suspected Predator
Predator Identification Guide
Species of Livestock Lost
Number of Livestock Lost
Was attack observed by Reporter? Yes No
Was loss confirmed by an expert? Yes No
Agency that confirmed loss?
Date of Incident / MM / DD YYYY
Time of Incident : HH MM AM/PM
County
Deer/Elk Hunting District
Township
Range
Section
Latitude (If Known)

(Decimal Degrees)
Longitude (If Known)

(Decimal Degrees)
Detailed Account of Observation
Livestock Producer (if different from Reporter) Mr. Ms. Mrs. Dr.
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Phone - (###) - ### ####
Email
Add my email address to a database for access by predator hunters for contact? Yes No

Report Date:5/19/2013 6:24:27 AM