Pesticide Compliance Damage Claim

Concerned about pesticides?

Sec 22-3417, Idaho Code states:

Any individual suffering loss or damage resulting from the use or application by others of any pesticide must file with the department a written report of loss which contains but is not limited to the following information:

1. 1. The name and address of the claimant; and
  2. The type of property alleged to be damaged; and
  3. The name of the individual applying the pesticide and allegedly responsible; and
  4. The name of the owner or lessee of the property for whom such application of pesticide was made.

Pesticide Damage Claim

Pesticide Damage Claim

Sec 22-3417, Idaho Code states:

Any individual suffering loss or damage resulting from the use or application by others of any pesticide must file with the department a written report of loss which contains but is not limited to the following information:
- The name and address of the claimant; and
- The type of property alleged to be damaged; and
- The name of the individual applying the pesticide and allegedly responsible; and
- The name of the owner or lessee of the property for whom such application of pesticide was made.

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Email

Phone Number

Date of Application

Location of Damage

Description of Damage

First Name of Applicator

Last Name of Applicator

Applicator Company Name

Applicator Company Phone Number

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Numeric Field

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Textarea

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ver: 3.5.2a | last updated: April 16, 2024 at 03:48 pm