UBRC Record No.__________

UTAH BIRD RECORDS COMMITTEE

VERIFICATION OF UNUSUAL SIGHT RECORD FOR UTAH

COMMON NAME:	SCIENTIFIC NAME:

DATE:	TIME:	LENGTH OF TIME OBSERVED:

NUMBER:	AGE:	SEX:

LOCATION:

COUNTY:	LATILONG:	ELEVATION:

DISTANCE TO BIRD: OPTICS USED::

WEATHER:

LIGHT CONDITIONS:

DETAILED DESCRIPTION OF BIRD:

SONG OR CALL AND METHOD OF DELIVERY:

BEHAVIOR:

HABITAT:

SIMILAR SPECIES AND HOW WERE THEY ELIMINATED:

PREVIOUS EXPERIENCE WITH THIS AND SIMILAR SPECIES:
REFERENCES CONSULTED:

DESCRIPTION FROM: NOTES TAKEN AT TIME OF SIGHTING_____, NOTES MADE LATER_____, FROM MEMORY_____

OBSERVER:	SIGNATURE:

ADDRESS:

CITY:	STATE: ZIP:

E-MAIL ADDRESS:

PERMISSION: I GIVE MY PERMISSION TO POST THIS SIGHTING RECORD ON THE INTERNET IN AN AREA:

OPEN TO THE GENERAL PUBLIC____, RESTRICTED TO THE RECORDS COMMITTEE MEMBERS_____

OTHER OBSERVERS WHO INDEPENDENTLY IDENTIFIED THIS BIRD:

DATE PREPARED:
ADDITIONAL MATERIAL: PHOTO_____, DRAWING_____, TAPE_____, OTHER

RETURN THIS FORM TO:	UTAH BIRD RECORDS COMMITTEE

2795 Indian Hills Drive

Provo, UT 84604

OR EMAIL TO:	records@utahbirds.org