Form 3-200-73 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

Type of Activity:

(enter address from pages 5 or 6 of application)

Re-Export of Wildlife (CITES)

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

2.d. Zip code/Postal code:

2.e. County/Province

2.f. Country

D.

All applicants MUST complete

1.

Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount of $75. 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

2.
3.

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)

Please continue to next page

Form 3-200-73

Rev. <>

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E.

Re-Export of Wildlife (CITES)

NOTE 1: If you are re-exporting CITES Appendix II or III species, the application can be submitted to the Office of
Law Enforcement (OLE) [exceptions apply to Pre-Convention Appendix II and III specimens]. See pages 5 and 6
for addresses. Applications that are submitted to the Law Enforcement Office must be submitted within the
region where you reside.
Applications that contain species that are also covered under the Endangered Species Act (ESA), the Wild Bird
Conservation Act (WBCA), Marine Mammal Protection Act (MMPA) or the Migratory Bird Treaty Act (MBTA)
must be submitted to the Division of Management Authority (DMA).
NOTE 2: If you are a Customshouse broker or a freight forwarder applying on behalf of your client, you must attach
to this application the documentation that shows you have Power of Attorney to act on your client’s behalf.
Provide the following information. Complete all questions on the application. Mark questions that are not
applicable with "N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you submit,
indicate the application question number you are addressing. If applying for more than one specimen, be sure to
indicate which specimen is being addressed in each response.
1.

Provide the following information (You may use the attached corresponding inventory sheet): Please do NOT
include Quarantine, Immunization or Health records unless they document transfer of ownership.
a.
Scientific Name (genus, species, subspecies):
b.
Common Name:
c.
Source (as listed on the foreign CITES permit used to import the specimen):
d.
Quantity:
e.
Description (if Live animals, provide a complete list of identifiers e.g. tattoo list, band list, etc):
f.
Live or Dead (circle appropriate answer)
g.
Gender (if Live):
h.
Country of origin and CITES export permit number:
i.
Country of origin CITES export permit issuance date:
j.
Country of last re-export CITES permit number (if applicable):
k.
Country of last re-export CITES permit issuance date (if applicable):

2.

Indicate the current location of specimen(s) __________________________________________

3.

Provide:
a.* A copy of cancelled foreign CITES export or re-export document (validated by OLE) issued by the
appropriate CITES office in the country from which the wildlife was imported, and
b.* Wildlife Declaration (Form 3-177), stamped cleared by OLE, (provide either a hard copy or electronic
release; not applicable for plants); OR
c.
If you did not make the original import, provide a copy of the importer's documents outlined above and
the invoice or other document that shows you acquired the wildlife from the original importer or history
of transactions that demonstrate chain of ownership. NOTE: Redacted documents will not be
accepted. For further instructions contact the permit issuing office directly.
d.
If protected by the Wild Bird Conservation Act (WBCA), provide a copy of the WBCA import permit.

4.

Indicate the purpose of the export (check all that apply):
 Commercial
Zoo
 Botanical garden
 Traveling Exhibition
 Scientific
 Personal
 Medical (including biomedical research)
 Educational
 Reintroduction/introduction
 Breeding in captivity or Artificial Propagation

*Permits cannot be issued without the document being stamped cancelled and cleared by OLE.
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5.

Is this shipment a sample collection being exported for temporary exhibition or display purposes and
accompanied by a valid ATA carnet?
 NO
 YES; If available, provide ATA carnet document number _________________
(Application must be processed by DMA, see address on page 5)

6.

Provide the name and address of person or facility receiving the shipment (if self, provide your address
abroad).
Name:
Address
City, Country, Postal Code

7. U.S. address (not a P.O. Box) for foreign applicant. (50 § 13.12 requires this information for issuance).
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
8. Applicants residing or located outside the United States conducting commercial activities. The name,
physical address and telephone number of your agent that is located in the United States who will maintain your
records for five (5) years from the expiration of the permit. If the location is the same as Question 3, then indicate
“same as Question 3". (50 § 13.12 and 13.46 requires this information).
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
9.

For live animals, the transport conditions must comply with the CITES Guidelines for Transport of Live
Animals or, in the case of air transport, with the International Air Transport Association (IATA) live animal
regulations (contact airline for information). As such, describe:
a.
The type, size, and construction of any shipping container; and
b.
The arrangements for watering or otherwise caring for the wildlife during transport.

10.

For the non-commercial re-export of CITES Appendix-I species (applications must be submitted to DMA),
provide a copy of the CITES import permit, or evidence one will be issued by the Management Authority of
the country to which you plan to export the specimen(s). In accordance with Article III of the CITES treaty, it
is required that import permits are issued before the corresponding export permit.

11.

Enter the U.S. port through which the re-export will occur. ____________________________ (All wildlife,
including parts and products, must be declared to and inspected by a Wildlife Inspector from the U.S. Fish and
Wildlife Service Office of Law Enforcement prior to leaving the United States. A list of designated ports
(where an inspector is posted) is available from http://www.fws.gov/le/ImpExp/Contact_Info_Ports.htm.

12.

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

13.

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

14.

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

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Re-export of Wildlife (CITES)
Inventory Page

a. Scientific
Name
(genus, species,
subspecies)

EXAMPLE:
Caiman
crocodilus fusus

b. Common
Name

brown caiman

c.
Source
Code
Listed
on
Country
of Origin
Permit
C

d. Unit of
Measure
&
Quantity

NO/1

e.
Description
of
Specimen
(include
tattoo/band
lists if
applicable)
watch
straps

i.
f.
Live
?
(Y/N)

g.
Gender
(If Live)

N

N/A

h. Country of
Origin and
Country of
Origin Permit
Number

CO/123345

Country of
Origin
Export
Permit
Issuance
Date

07/05/1998

Enter Column
Totals for No.
Animals/Products
etc.

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j. CITES
Country of
Last ReExport and
Re-Export
Permit No ( if
applicable)

CH/89076

k.
Last ReExport
Certificate
Issuance
Date. (if
applicable)

07/05/2000

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

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

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Fax: (847) 298-7669

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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 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, and C through 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.
ALL APPLICANTS COMPLETE SECTION E:
Question 7. Enter the complete U.S. address. This can be a temporary address (such as a hotel, relative, etc.). 50 § 13.12 requires this information
for issuance.
Question 8. Enter the complete name and physical address where your records (as defined in 50 § 13.46) will be maintained for five (5) years from
the date of expiration of the license. This can be a customshouse broker, relative, etc. It cannot be a retail postal or mail service center. 50 § 13.12
requires this information for issuance.

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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 display 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
Re-Export of Wildlife application is 30 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 nonconfidential 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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