Lobster trap tag replacement request form

LOBSTER TRAP TAG REPLACEMENT FORM
Your request for the replacement of trap tags in an amount exceeding 10 % of your
total trap allocation has been approved by the National Marine Fisheries Service.
You may order your replacement tags by submitting this completed form and payment to the address
below:

Stoffel Seals Corporation
P.O. Box 825 - Dept. 3
Nyack, NY 10960-0825
Tel. (845) 348-7188
Name:

.

P.O. Box / Street:

.

City/State/Zip:

.

Telephone Number: (

)

.
Federal Permit #:__________________

Vessel Name:

Vessel Documentation # or State Registration #:

.

Maximum Number of Tags Authorized by NMFS:

Cert#:

Number of Replacement Tags Requested:

X $0.16 per tag = $

.

* State Tax = $

.

Total Amount Enclosed /Authorized:
Method of Payment:

Visa

Credit Card Number:

MasterCard

$

.

Certified Check/ Money Order
Expiration Date:

.

**$50.00 minimum on credit card purchases – Orders under $50.00 must use certified check or money order.**
Please make cashier=s checks or money orders payable to: Stoffel Seals Corporation. No cash, or
personal or corporate checks will be accepted. *If tax exempt, please complete and return a tax
exemption form for your state of residence. Orders received without a tax exemption certificate, or
applicable sales tax, will not be processed.
I certify that the information provided on this form is true, complete and correct to the best of my
knowledge, and made in good faith. Making a false statement on this form is punishable by law (18
U.S.C. 1001). Forms that are not signed and dated will not be processed.
Signature of Applicant:

Date:

.

Signature of NMFS Approving Official:

Date:

.

OMB # 0648-0202

EXP 11/30/2009

This collection is authorized under the Magnuson-Stevens Fishery Management and
Conservation Act (16 U.S.C. 1801 et. seq.). The information will be used in the management of
the American lobster fishery by helping to restrict the number of traps fished by an individual
permit holder and thus enforce that provision of the effort reduction program for the American
Lobster Fishery.
Public reporting burden for the collection of information is estimated at 3 minutes for reporting
lost or missing tags and ordering replacement tags. These estimates include the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to the National Marine Fisheries Service, Lobster Trap Tag Program,
One Blackburn Drive, Gloucester, MA 01930-2298.
Notwithstanding any other provision of law, no person is required to respond to, nor shall a
person be subject to the requirements of the Paperwork Reduction Act, unless that collection of
information displays a currently valid OMB Control Number.