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State of Connecticut

Connecticut Agricultural Experiment Station
and the
Department of Energy and Environmental Protection

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In-State Firewood Transportation
Self Issued Certificate of Origin

When transporting untreated firewood within Connecticut, you must keep a signed confirmation copy of this completed document with you. 

This Self-Issued Certificate is for cut and split firewood or wood intended to be cut and split and used as fuel for heating purposes.

Part I: Transporter Information

Transporter Name: 
Mailing Address: 
City/Town:  State:  ZIP Code: 
Home, Business or Cell Phone:   
E-mail:    

Part II: Source of Firewood

Source Street Address: 
Source City/Town: 
Source County (refer to county map)

NOTE: If the source of the firewood is in an affected county, then additional regulations apply
Contact CAES at 203-974-8474 prior to moving firewood out of or through an affected county:  

Source ZIP Code: (Look Up a ZIP Code)

Part III: Destination of Firewood Being Transported

Destination Street Address: 
Destination City/Town: 
Destination County (refer to county map)
Destination ZIP Code(Look Up a ZIP Code
Approximate Volume Being Transported (In Cords): 

Part IV:  Transporter Certification

The transporter must sign this part and keep this completed signed copy when transporting firewood. 

I have personally examined and am familiar with the information submitted in this document and all attachments thereto, and I certify that based on reasonable investigation, including my inquiry of the individuals responsible for obtaining the information, the submitted information is true, accurate and complete to the best of my knowledge and belief.

I understand that firewood shall not be moved into Connecticut without meeting the requirements of section 22-84-5g of the Regulation of Connecticut State Agencies (RCSA). I further understand that this Self-Issued Certificate is for cut and split firewood or wood intended to be cut and split and used as fuel for heating purposes.

Any person or employee or agent of that person, who violates any provision of section 22-84-5g of the RCSA, shall be subject to enforcement as authorized by section 22-84 of the General Statutes or section 22-84-5e of the RCSA.
  
Signature: ____________________________________
 
Name of Transporter:   Date Submitted: Thursday, July 18, 2019

 

In order to print a confirmation copy for signature, you must hit "Submit Form" above and the confirmation copy will be displayed.

This certificate is valid for one month from the date submitted.  Retain this document for your personal records for 365 days after self issuance.

For questions, please contact CAES at CAES.StateEntomologist@ct.gov or 203-974-8474 or the DEEP Forestry Division at deep.forestry@ct.gov or 860-424-3630.

79 Elm Street, Hartford, CT 06106-5127 / Phone: 860-424-3000
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