North Shore Mosquito Abatement District
Dead Bird Finding Report Form

The NSMAD is interested in your findings. This form will help us in tracking the
distribution of the West Nile Virus for our control efforts in our district. If you could
please fill out the following information and when finished please click on the
"Send Form" button below. Your information is greatly appreciated.

For More Information: "Illinois Department of Public Health: Dead Bird Collection"

If you would like to leave a message instead with the NSMAD district
office,  @ (847) 446 - 9434:  Please Press/Enter in TWO(2) anytime during
the welcome message and Report your Dead Bird Finding.

Dead Bird Finding Report Form:

**Everything in ORANGE is Required On Form + Please...**

Name:

Telephone#:

Email Address:

Location where Bird was found:

*Address:

*City:

*Type of Bird (Select Bird(s)):

If "Other" is Selected Above,Please list Type Found:

*Total # of Birds Found:

*Date Dead Bird was Discovered:

*Please Describe Here*i
The Exact Location of the
Dead Bird(s) & Your
Additional Findings.....

**INFO in ORANGE is Required On the Bird Form + Please...**