Mosquito Spraying Avoidance Request

I DO NOT wish for my property to be included in the adulticiding (ground spraying) service provided by mosquito control using a vehicle mounted ultra-light volume (ULV) spray machine for the following reason(s):*

BeekeeperOther

Other (Please Explain):

I understand that a new release form must be obtained from, completed, and returned to Mosquito Control each calendar year.

I understand that a yard inspection for standing water/mosquito breeding habitat is required.

Please Note:
Mosquito Control reserves the right to spray in the case of a West Nile Virus positive test result within a mile and a half of the residence.

Name:*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Please enter a valid phone number.

Email Address:*

example@example.com

Signature:*

Clear

Date/Time