Form 3-200-52 Federal Fish and Wildlife Permit Application Form

Expires XX/XX/XXXX
OMB No. 1018-0093

Department of the Interior
U.S. Fish and Wildlife Service

Federal Fish and Wildlife Permit Application Form
Return to: U.S. Fish and Wildlife Service
(Enter address from pages 4 and 5 of application)

Type of Activity:

REISSUANCE, RENEWAL, OR AMENDMENT OF A PERMIT
(For this application, all permits, registrations, and
certificates are referred to as a permit.)

Complete Sections A or B, C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.
See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A.

Complete if applying as an individual

1.a. Last name

1.b. First name

1.c. Middle name or initial

1.d. Suffix

2. Date of birth (mm/dd/yyyy)

3. Social Security No.

4. Occupation

5. Affiliation/ Doing business as (see instructions)

6.a. Telephone number

6.b. Alternate telephone number

6.c. Fax number

6.d. E-mail address

B.

Complete if applying on behalf of a business, corporation, public agency, tribe, or institution

1.a. Name of business, agency, tribe, or institution

1.b. Doing business as (dba)

2. Tax identification no.

3. Description of business, agency, tribe, or institution

4.a. Principal officer Last name

4.b. Principal officer First name

5. Principal officer title

7.a. Business telephone number

C.

4.c. Principal officer Middle name/ initial

4.d. Suffix

6. Primary contact

7.b. Alternate telephone number

Applicant address

7.c. Business fax number

7.d. Business e-mail address

All applicants complete address information

1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)

1.b. City

1.c. State

1.d. Zip code/Postal code:

1.e. County/Province

1.f. Country

2.a. Mailing Address (include if different than physical address; include name of contact person if applicable)

2.b. City

2.c. State

D.
1.

2.
3.

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

All applicants MUST complete
Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount indicated on pages 6 and 7. Federal, tribal, State, and local
government agencies, and those acting on behalf of such agencies, are exempt from the processing fee – attach documentation of fee exempt status as outlined in
instructions. (50 CFR 13.11(d))
Do you currently have or have you ever had any Federal Fish and Wildlife permits?
Yes
If yes, list the number of the most current permit you have held or that you are applying to renew/re-issue: _________________________________No
Certification: I hereby certify that I have read and am familiar with the regulations contained in Title 50, Part 13 of the Code of Federal Regulations and the other
applicable parts in subchapter B of Chapter I of Title 50, and I certify that the information submitted in this application for a permit is complete and accurate to the
best of my knowledge and belief. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001.
________________________________________________________________________________________________________________________
Signature (in blue ink) of applicant/person responsible for permit (No photocopied or stamped signatures)
Date of signature (mm/dd/yyyy)

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E. REISSUANCE, RENEWAL, OR AMENDMENT OF A PERMIT (For this application, all
permits, registrations, and certificates are referred to as a permit.)
NOTE 1: Applications must be submitted to the office that issued the initial permit. This form cannot
be used for lost or damaged permit. Lost or damaged permit must use form 3-200-66.
NOTE 2: If you are renewing your Import/Export license (required for commercial activities), use
form 3-200-3 (http://www.fws.gov/forms/3-200-3.pdf ) and submit to appropriate Office of Law
Enforcement address.
NOTE 3: If you are renewing or amending a master file for multiple shipments or a COSE, use the
appropriate form for proposed activity (form 3-200-29 for samples; 3-200-30 for circus/traveling
exhibits; 3-200-33 for Artificially Propagated Plants; 3-200-39 for COSEs)
(http://www.fws.gov/forms/ display.cfm?number1=200).
1.

Permit number. Enter the permit number to be reissued/renewed __________________. The
original permit must be submitted with this application.

2.

Past activities.
a.
Provide copies of all cleared documents and form 3-177 (FWS declaration of wildlife)
associated with this permit.
b. Provide a summary detailing activities conducted under this permit, as well as a brief
statement of why you are seeking reissuance/renewal.

3.

Annual Report. If required by your permit, provide an annual report as conditioned. (Disregard
if you have already submitted your annual report.)

4.

Captive-Bred Wildlife Registration (CBW): If the location of activities has changed, attach a
description and photographs or diagrams (no blueprints) of the current facilities. If a change in
personnel (e.g., principal officer, curator, and primary animal care staff) has occurred, provide a
brief description of their expertise in caring/handling of the species.

5.

Sport-hunted trophies: If you did not hunt during the hunting season stated in your original
application, you are not eligible for a renewal. Please submit a new application form.

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6.

Certification. Complete one of the statements below and supply any additional documentation
requested:
a.
For NO CHANGES to original application:
I certify that the information submitted in support of my original application for the permit
indicated above has not changed and is still currently correct. I hereby request reissuance
or renewal of this permit.
Permittee’s signature: ____________________________________
b.

Date: ___________

For CHANGES to original application:
I certify that the information submitted in support of my original application for the permit
indicated above is still currently correct EXCEPT for the changes noted on the attached,
signed page(s). I hereby request re-issuance or renewal of this permit with the indicated
changes.
[On an attached page(s), provide a complete description of any changes (e.g., change in
principal officer, personnel, address, location of activities, port location.) Please sign each
attached page. Also, please note that we may ask you to submit additional information.]

Permittee’s signature: ____________________________________

Date: ___________

7.

Address where you wish permit mailed (if different than page 1):
_____________________________________________________________________________
_____________________________________________________________________________

8.

If you wish the permit to be sent to you by means other than regular mail, provide an air bill, prepaid envelope, or billing information:
_____________________________________________________________________________

9.

Who should we contact if we have questions about the application? (Include name, phone
number, and email):
_____________________________________________________________________________

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CITES Permit Offices

Division of Management Authority (DMA)
U.S. Fish and Wildlife Service
4401 N. Fairfax Drive, Room 212
Arlington, VA 22203
1-800-358-2104 or 703-358-2104

Office of Law Enforcement
NOTE: The application must be submitted to the office within the region you reside.
Region 1: California, Guam, Hawaii, Idaho, Nevada, Oregon, & Washington
Los Angeles
370 Amapola Ave., #114
Torrance, California 90501
Phone: (310) 328-6307
Fax: (310) 328-6399

San Francisco
1633 Old Bayshore Highway, Suite. 248
Burlingame, California 94010
Phone: (650) 876-9078
Fax: (650) 876-9701

Guam
415 Chalan San Antonio Road
Baltej Pavillion, Suite 209
Tamuning, Guam 96913-3620
Phone: (671) 647-6064
Fax: (671) 647-6068

Honolulu
3375 Koapaka St., #B296
Honolulu, Hawaii 96819-1867
Phone: (808) 861-8525
Fax: (808) 861-8515

Portland
P.O. Box 55206
Portland, Oregon 97238
Phone: (503) 231-6135
Fax: (503) 231-6133

Blaine
9925 Pacific Highway
Blaine, Washington 98230
Phone: (360) 332-5388
Fax: (360 )332-3010

Seattle
19339D 28th Avenue South
Seattle, Washington 98188
Phone: (206) 764-3463
Fax: (206) 764-3485

Region 2: Arizona, New Mexico, Oklahoma, & Texas
U.S. Fish & Wildlife Service
Office of Law Enforcement
2450 W. Broadway Road
Suite 113
Mesa, AZ 85202
Phone: (480) 967-2007 Fax: (480) 966-9766

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Region 3: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Ohio, & Wisconsin
U.S. Fish & Wildlife Service
Office of Law Enforcement
10600 Higgins Road, Suite 200
Rosemont, Illinois 60018
Phone: (847) 298-3250 Ext: 10
Fax: (847) 298-7669

Region 4: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina,
South Carolina, Puerto Rico, & Tennessee
Atlanta
4341 International Parkway,
Suite #104
Atlanta, Georgia 30354
Phone: (404) 763-7959
Fax: (404) 366-7031

Miami
Mail: 10426 NW 31 Terrace
Miami, Florida 33172
Physical: 6105 NW 18th St., Room 405
Miami, Florida 33122
Phone:(305) 526-2994 or 2620
Fax:(305) 526-7480

New Orleans
2424 Edenborn, Room 100
Metairie, Louisiana 70001
Phone: (504) 219-8870
Fax: (504) 219-8868
Region 5: Connecticut, District of Columbia, Delaware, Maine, Maryland, Massachusetts, New
Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, & West Virginia
U.S. Fish & Wildlife Service
Office of Law Enforcement
70 E. Sunrise Hwy, Suite 419
Valley Stream, NY 11580
Tel: (516) 825-3950
Fax: (516) 825-3597
Region 6: Colorado, Kansas, Montana, Nebraska, North Dakota, South Dakota, Utah, & Wyoming
U.S. Fish & Wildlife Service
Office of Law Enforcement
Denver International Airport
P.O. Box 492098
Denver, Colorado 80249
Phone: (303) 342-7430
Fax: (303) 342-7433
Region 7: Alaska
Anchorage
U.S. Fish & Wildlife Service
Office of Law Enforcement
P.O. Box 190045
4600 Postmark Drive, Suite NB207
Anchorage, Alaska 99519
Phone: (907) 271-6198
Fax: (907) 271-6199

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Fairbanks
U.S. Fish & Wildlife Service
Office of Law Enforcement
1412 Airport Way
Fairbanks, Alaska
Phone: (907) 456-2335
Fax: (907) 456-2356

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PERMIT FEES – EXCERPTS FROM 50 CFR 13

November 2010

d) Fees. (1) Unless otherwise exempted under this paragraph (d), you must pay the required permit processing fee at the time that
you apply for issuance or amendment of a permit. You must pay in U.S. dollars. If you submit a check or money order, it must be
made payable to the ―U.S. Fish and Wildlife Service.‖ The Service will not refund any application fee under any circumstances if
we have processed the application. However, we may return the application fee if you withdraw the application before we have
significantly processed it.
(2) If regulations in this subchapter require more than one type of permit for an activity and the permits are issued by the same
office, the issuing office may issue one consolidated permit authorizing the activity in accordance with §13.1. You may submit a
single application in such cases, provided that the single application contains all the information required by the separate
applications for each permitted activity. Where more than one permitted activity is consolidated into one permit, the issuing office
will charge the highest single fee for the activity permitted.
(3) Circumstances under which we will not charge a permit application fee are as follows:
(i) We will not charge a permit application fee to any Federal, tribal, State, or local government agency or to any individual or
institution acting on behalf of such agency. Except as otherwise authorized or waived, if you fail to submit evidence of such status
with your application, we will require the submission of all processing fees prior to the acceptance of the application for
processing.
(ii) As noted in paragraph (d)(4) of this section.
(iii) We may waive the fee on a case-by-case basis for extraordinary extenuating circumstances provided that the issuing permit
office and a Regional or Assistant Director approves the waiver.
(4) User fees. The following table identifies specific fees for each permit application or amendment to a current permit. If no fee is
identified under the Amendment Fee column, this particular permit either cannot be amended and a new application, and
application fee, would need to be submitted or no fee will be charged for amending the permit (please contact the issuing office for
further information).

Amendment
fee

Type of permit

Fee

Eagle Transport—Scientific or Exhibition

75

Eagle Transport—Native American Religious Purposes

No fee

No fee

ESA Interstate Commerce

100

50

ESA and CITES Import/Export and Foreign Commerce

100

50

ESA and CITES Museum Exchange

100

50

ESA Captive-bred Wildlife Registration

200

100

—Renewal of Captive-bred wildlife registration

100

CITES Import (including trophies under ESA and MMPA)

100

50

CITES Export

100

50

CITES Pre-Convention

75

40

CITES Certificate of Origin

75

40

CITES Re-Export

75

40

CITES Personal Effects and Pet Export/Re-Export

50

CITES Appendix II Export (native furbearers and alligators—excluding live animals) 100

50

CITES Master File (includes files for artificial propagation, biomedical, etc. and
covers import, export, and re-export documents)

100

200

—Renewal of CITES Master File

100

—Single-use permits issued on Master File

5 each

CITES Annual Program File
—Single-use permits issued under Annual Program

50
5 each

CITES replacement documents (lost, stolen, or damaged documents)

50

CITES Passport for Traveling Exhibitions and Pets

75 per animal

CITES/ESA Passport for Traveling Exhibitions

100 per animal

CITES Introduction from the Sea

100

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50

50
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CITES Participation in the Plant Rescue Center Program

No fee

CITES Registration of Commercial Breeding Operations for Appendix-I wildlife

100

CITES Request for Approval of an Export Program for a State or Tribe (American
Ginseng, Certain Furbearers, and American Alligator)

No fee

No fee

Import/Export License

100

50

Designated Port Exception

100

50

Injurious Wildlife Permit

100

50

—Transport Authorization for Injurious Wildlife

No fee

25

Personal Pet Import

50

WBCA Scientific Research, Zoological Breeding or Display, Cooperative Breeding

100

50

WBCA Approval of Cooperative Breeding Programs

200

100

—Renewal of a WBCA Cooperative Breeding Program
WBCA Approval of a Foreign Breeding Facility

50
250 per species

(5) We will charge a fee for substantive amendments made to permits within the time period that the permit is still valid. The fee
is generally half the original fee assessed at the time that the permit is processed; see paragraph (d)(4) of this section for the exact
amount. Substantive amendments are those that pertain to the purpose and conditions of the permit and are not purely
administrative. Administrative changes, such as updating name and address information, are required under 13.23(c), and we will
not charge a fee for such amendments.
(6) Except as specifically noted in paragraph (d)(4) of this section, a permit renewal is an issuance of a new permit, and applicants
for permit renewal must pay the appropriate fee listed in paragraph (d)(4) of this section.
(e) Abandoned or incomplete applications. If we receive an incomplete or improperly executed application, or if you do not
submit the proper fees, the issuing office will notify you of the deficiency. If you fail to supply the correct information to complete
the application or to pay the required fees within 45 calendar days of the date of notification, we will consider the application
abandoned. We will not refund any fees for an abandoned application.
[70 FR 18317, Apr. 11, 2005, as amended at 72 FR 48445, Aug. 23, 2007; 73 FR 29083, May 20, 2008; 73 FR 42281, July 21,
2008; 74 FR 46875, Sept. 11, 2009]

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PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to an application for a U.S. Fish and Wildlife Service or CITES permit. The General Permit Procedures in 50
§ 13 address the permitting process. For simplicity, all licenses, permits, registrations, and certificates are referred to as a permit.
GENERAL INSTRUCTIONS:
Complete all blocks/lines/questions in Sections A or B, C, D, and E.
An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are filling in the
appropriate application form for the proposed activity.
Print clearly or type in the information. Illegible applications may cause delays.
Sign the application in blue ink. Faxes or copies of the original signature will not be accepted.
Mail the original application to the address at the top of page one of the application or if applicable on the attached address list.
Keep a copy of your completed application.
Please plan ahead. Allow at least 60 days for your application to be processed. Some applications may take longer than 90
days to process. (50 § 13.11)
Applications are processed in the order they are received.
Additional forms and instructions are available from http://www.fws.gov/forms/display.cfm?number1=200.
COMPLETE EITHER SECTION A OR SECTION B:
Section A. Complete if applying as an individual:
Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal information that
identifies the applicant. Fax and e-mail are not required if not available.
If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing power of
attorney must be included with the application.
Affiliation/ Doing business as (dba): business, agency, organizational, tribe, or institutional affiliation directly related to the activity
requested in the application (e.g., a taxidermist is an individual whose business can directly relate to the requested activity). The
Division of Management Authority (DMA) will not accept doing business as affiliations for individuals.
Section B. Complete if applying as a business, corporation, public agency, tribe, or institution:
Enter the complete name of the business, agency, tribe, or institution that will be the permittee if a permit is issued. Give a brief
description of the type of business the applicant is engaged in. Provide contact phone number(s) of the business.
Principal Officer is the person in charge of the listed business, corporation, public agency, tribe, or institution. The principal officer
is the person responsible for the application and any permitted activities. Often the principal officer is a Director or President.
Primary Contact is the person at the business, corporation, public agency, tribe or institution who will be available to answer
questions about the application or permitted activities. Often this is the preparer of the application.
ALL APPLICANTS COMPLETE SECTION C:
For all applications submitted to the Division of Management Authority (DMA) a physical U.S. address is required. Province and
Country blocks are provided for those USFWS programs which use foreign addresses and are not required by DMA.
Mailing address is address where communications from USFWS should be mailed if different than applicant’s physical address.
ALL APPLICANTS COMPLETE SECTION D:
Application processing fee:
An application processing fee is required at the time of application; unless exempted under 50 § 13.11(d)(3). The fee does not
guarantee the issuance of a permit. Fees will not be refunded for applications that are approved, abandoned, or denied. We
may return fees for withdrawn applications if no significant processing has occurred.
Documentation of fee exempt status is not required for Federal, tribal, State, or local government agencies; but must be
supplied by those applicants acting on behalf of such agencies. Those applicants acting on behalf of such agencies must submit a
letter on agency letterhead and signed by the head of the unit of government for which the applicant is acting on behalf, confirming
that the applicant will be carrying out the permitted activity for the agency.
Federal Fish and Wildlife permits:
List the number(s) of your most current FWS or CITES permit or the number of the most recent permit if none are currently valid. If
applying for re-issuance of a CITES permit, the original permit must be returned with this application.
Certification:
The individual identified in Section A, the principal officer named in Section B, or person with a valid power of attorney
(documentation must be included in the application) must sign and date the application in blue ink. This signature binds the
applicant to the statement of certification. This means that you certify that you have read and understand the regulations that apply to
the permit. You also certify that everything included in the application is true to the best of your knowledge. Be sure to read the
statement and re-read the application and your answers before signing.

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APPLICATION FOR A FEDERAL FISH AND WILDLIFE PERMIT
Paperwork Reduction Act, Privacy Act, and Freedom of Information Act – Notices

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and the Privacy Act of 1974 (5 U.S.C. 552a), please be
advised:
1.

The gathering of information on fish and wildlife is authorized by:
(Authorizing statutes can be found at: http://www.gpoaccess.gov/cfr/index.html and http://www.fws.gov/permits/ltr/ltr.html.)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;
Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50CFR 17;
Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;
Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), 50 CFR 18;
Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15;
Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;
Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), http://www.cites.org/ , 50 CFR 23;
General Provisions, 50 CFR 10;
General Permit Procedures, 50 CFR 13; and
Wildlife Provisions (Import/export/transport), 50 CFR 14.

2.

Information requested in this form is purely voluntary. However, submission of requested information is required in order to process
applications for permits authorized under the above laws. Failure to provide all requested information may be sufficient cause for the U.S. Fish
and Wildlife Service to deny the request. We may not conduct or sponsor and you are not required to respond to a collection of information
unless it displays a currently valid OMB control number.

3.

Certain applications for permits authorized under the Endangered Species Act of 1973 (16 U.S.C. 1539) and the Marine Mammal Protection Act of
1972 (16 U.S.C. 1374) will be published in the Federal Register as required by the two laws.

4.

Disclosures outside the Department of the Interior may be made without the consent of an individual under the routine uses listed below, if the
disclosure is compatible with the purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003)
a.
b.
c.
d.
e.

f.
g.

h.
i.
j.

Routine disclosure to subject matter experts, and Federal, tribal, State, local, and foreign agencies, for the purpose of obtaining advice relevant to
making a decision on an application for a permit or when necessary to accomplish a FWS function related to this system of records.
Routine disclosure to the public as a result of publishing Federal Register notices announcing the receipt of permit applications for public
comment or notice of the decision on a permit application.
Routine disclosure to Federal, tribal, State, local, or foreign wildlife and plant agencies for the exchange of information on permits granted or
denied to assure compliance with all applicable permitting requirements.
Routine disclosure to Captive-bred Wildlife registrants under the Endangered Species Act for the exchange of authorized species, and to share
information on the captive breeding of these species.
Routine disclosure to Federal, tribal, State, and local authorities who need to know who is permitted to receive and rehabilitate sick, orphaned,
and injured birds under the Migratory Bird Treaty Act and the Bald and Golden Eagle Protection Act; federally permitted rehabilitators;
individuals seeking a permitted rehabilitator with whom to place a bird in need of care; and licensed veterinarians who receive, treat, or diagnose
sick, orphaned, and injured birds.
Routine disclosure to the Department of Justice, or a court, adjudicative, or other administrative body or to a party in litigation before a court or
adjudicative or administrative body, under certain circumstances.
Routine disclosure to the appropriate Federal, tribal, State, local, or foreign governmental agency responsible for investigating, prosecuting,
enforcing, or implementing statutes, rules, or licenses, when we become aware of a violation or potential violation of such statutes, rules, or
licenses, or when we need to monitor activities associated with a permit or regulated use.
Routine disclosure to a congressional office in response to an inquiry to the office by the individual to whom the record pertains.
Routine disclosure to the General Accounting Office or Congress when the information is required for the evaluation of the permit programs.
Routine disclosure to provide addresses obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a
debtor to collect or compromise a Federal claim against the debtor or to consumer reporting agencies to prepare a commercial credit report
for use by the FWS.

5. For individuals, personal information such as home address and telephone number, financial data, and personal identifiers (social security number,
birth date, etc.) will be removed prior to any release of the application.
6. The public reporting burden on the applicant for information collection varies depending on the activity for which a permit is requested. The
relevant burden for a Reissuance or Renewal of a Permit application is 15 minutes. This burden estimate includes time for reviewing instructions,
gathering and maintaining data and completing and reviewing the form. You may direct comments regarding the burden estimate or any other
aspect of the form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, Mail Stop 222, Arlington Square, U.S.
Department of the Interior, 1849 C Street, NW, Washington D.C. 20240.
Freedom of Information Act – Notice
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request that you identify any information
that should be considered privileged and confidential business information to allow the Service to meet its responsibilities under FOIA. Confidential business
information must be clearly marked "Business Confidential" at the top of the letter or page and each succeeding page and must be accompanied by a non-confidential
summary of the confidential information. The non-confidential summary and remaining documents may be made available to the public under FOIA [43 CFR
2.13(c)(4), 43 CFR 2.15(d)(1)(i)].

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