SECTION 1 – Notice of Violation	SECTION 2 – Issued To (Operator)
You are hereby charged with a violation of Code of Virginia §10.1-1181.2(H) – Failure to notify the State Forester of a Commercial Timber Harvesting Operation. You are being assessed a civil penalty payable to the State Forester within 30 days of the issue date of this notice. If you want to challenge this violation, you may request an Informal Conference to present your case.
Operator Name	NAID Number
Operator Address
VA
City	State	Zip
Issue Date of Notice	Date Due	Phone
$
No. Prior Violations for Previous 24 Months	Civil Penalty Assessed	Operator Signature
SECTION 3 – Harvest Inspection Information
A Virginia Department of Forestry Inspector has inspected a commercial timber harvest:	If you have any questions regarding this notice or if you want to request an Informal Conference to challenge this charge, please contact the VDOF Regional Office at:
Inspector Name (Print)	Badge Number
AM/PM	VDOF Regional Office Phone Number
Date of Inspection	Time of Inspection
Location Description of Timber Harvest	Inspector Signature	Date
County of Timber Harvest	Estimated Harvest Start Date	Harvest Number (VDOF Use Only)
Mail penalty payment (payable to “State Forester”) to: Virginia Department of Forestry, 900 Natural Resources Drive, Suite 800, Charlottesville, VA 22903
White - Area Office	** Include a copy of this form with your payment **	Yellow - Operator