Observer Name Date of Observation JanFebMar AprMayJun JulAugSep OctNovDec 12345678910111213141516171819202122232425262728293031 Address City State Zip Code Phone Number E-mail Address * Burrowing Owl Location (include distance to nearest town and roads) County UTM Coordinates (if GPS available) Datum (if GPS available, NAD 27 preferred) Latitude/Longitude Land Ownership (example, private) How many owls did you observe? How many were adults? Were the owls in urban habitat? Yes No Is the burrow in danger of being destroyed? Yes No Were prairie dogs present? Yes No Comments (example, behavior or color bands observed)

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