Insect Identification Request	AG-387 4-24-02
Identification Request No.	(For use by specialist only)
Date submitted for Identification
Collection Data:
IDENTIFICATION REQUEST	County	Date collected
Town or other specific locality
Habitat or host
Collector’s name, address
Other Information
County Agent
IDENTIFICATION REPORT	Referring specialist	Date
Identification:
Common name (if any)
Scientific name
Determined by
Date returned to Specialist
IDENFIFICATION FOLLOWUP	Economic significance (if any)
Recommended control measures (if any)
Signature Extension Entomologist	Date