Form 3-200-26 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 page 4 or 5 of application)

Type of Activity:
Export of skins of 7 native species: bobcat, lynx, river otter,
Alaskan brown bear, Alaskan black bear, Alaskan gray wolf, and
American alligator (CITES)

Complete Sections A or B, and 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

4.d. Suffix

6. Primary contact

7.a. Business telephone number

C.

4.c. Principal officer Middle name/ initial

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 $100. 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 3-200-26

Rev.

Page 1 of 7

E. Export of skins of 7 native species: bobcat, lynx, river otter, Alaskan brown bear, Alaskan black
bear, Alaskan gray wolf, and American alligator (CITES)
Note: Applications that are submitted to the Law Enforcement Office must be submitted within the region
where you reside. If the skin is from a sport-hunted trophy, please use Form 3-200-28 and submit the
application to the Division of Management Authority (DMA).
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.
1. Provide the following:
Scientific name

Common name

Alligator
mississippiensis

American
alligator

Ursus arctos

Alaskan brown
bear*

Ursus americanus

Alaskan black
bear*

Canis lupus

Alaskan gray
wolf*

Lynx rufus

Bobcat

Lynx canadensis

Lynx

Lontra canadensis

River otter

Taken from
the Wild or
captivebred

Quantity

Description (e.g., raw
or tanned)

State where
specimens
were
obtained

* = Permits may be issued by Region 7, Alaska or DMA Only.
2. Provide a list of the complete CITES Tag numbers [e.g. FL MIS 0712345] or Replacement Tag number
[e.g. FWS REPL 0123456]. Tags must be inserted through the skins and permanently locked in place at the time
of export. NOTE: Replacement tags must be obtained before submitting your application (broken tags must be
surrendered at the time of requesting replacement tags) [See 50 § 23.69(c)].
Electronic submission of inventories: Because some applications contain extensive inventories, you may provide
electronic versions. Such a submission may assist in expediting the processing of your application since it may reduce
data entry by the U.S. Fish and Wildlife Service. You may include a disk containing your information or check here
 if you would like to be contacted to provide it via email.

Form 3-200-26

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Page 2 of 7

3. U.S. address (not a P.O. Box) for foreign applicant. (50 § 13.12 requires this information for issuance).
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4. 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).
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
5. Provide the name and address of the recipient in the foreign country (if self, provide foreign address).
Name:_______________________________________________________________________________________
Address:_____________________________________________________________________________________
City, Country, Postal Code_______________________________________________________________________
6. Current location of skins: ____________________________________________________________________
7. Provide a copy of your valid Import/Export License.
8. Enter the U.S. port through which the 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 at http://www.fws.gov/le/ImpExp/Contact_Info_Ports.htm.)
9. Address where you wish permit mailed (if different than page 1):
____________________________________________________________________________________________
___________________________________________________________________________________________
_____________________________________________________________________________________________________

10. 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:
____________________________________________________________________________________________
____________________________________________________________________________________________
11. Who should we contact if we have questions about the application? (Include name, phone number, and email):
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Form 3-200-26

Rev.

Page 3 of 7

CITES Permit Offices
Division of Management Authority (DMA)
4401 N. Fairfax Drive, Room 212
Arlington, VA 22203
Phone: 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
Tel: (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

Form 3-200-26

Rev.

Fax: (847) 298-7669

Page 4 of 7

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

Form 3-200-26

Rev.

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

Page 5 of 7

PERMIT APPLICATION FORM INSTRUCTIONS
The following instructions pertain to the standard permit form 3-200 that must be completed as 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 will be 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.
ALL APPLICANTS COMPLETE SECTION E:
Question 3. 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 4. 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.

Form 3-200-26

Rev.

Page 6 of 7

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 andhttp://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), 50 CFR 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 an export of skins of 7 native species: bobcat, lynx, river otter, Alaskan brown bear, Alaskan black bear, Alaskan gray wolf, and American
alligator application is 20 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)].

Form 3-200-26

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