Federal permit form for vessels fishing for wreckfish of

U.S. DEPARTMENT OF COMMERCE, NOAA
NMFS PERMITS TEAM, F/SER1
263 13TH AVENUE SOUTH
ST. PETERS BURG , FL 33701
727/824-5326 (8am - 4:30pm EST)

OMB NO. 0648-0205
Approval Expires: 10/31/2006

FEDERAL PERMIT APPLICATION
VESSELS FISHING FOR WRECKFISH OFF THE SOUTH ATLANTIC STATES
APPLICATION FEE: $50.00

REPLACEMENT FEE: $18.00

FOR OFFICE USE ONLY
C H E C K/M O N E Y O R D E R NO .

EXP. DATE:

:
R E V IE W E R ’S IN IT IA L S /D A T E :

V IO L A T IO N N O ./ D AT E :

C L E A R E D D A TE /IN IT IA L S :

N O N - RE P O R T IN G H O L D D A T E :

C L E A R E D D AT E :/ IN IT IA L S :

APRIL 16, 2003 - JANUARY 14, 2004

SECTION 1 VESSEL INFORMATION (please type or print legibly)
Officia l No. (C oas t Gu ard D oc. or S tate R egis tration N o.)

Home Port (City & State)

Name of Vessel

Len gth (ft.)

Horsepower

SECTION 2 WRECKFISH SHAREHOLDER INFORMATION (required)
S ha re ho ld er N am e

Shareholder Certificate No.

Area code/Phone No.

Mailing Address
City

Sta te

Zip Code

Federal ID No.
Date of Birth or Date Corporation Formed: Month

Day

Year

SECTION 3 APPLICANT INFORMATION (please type or print legibly)
O w ne r’s Na m e

Area code/Phone No.

Mailing Address

City

Federal ID No.

Sta te

Date of Birth or Date Corporation Formed: Month

Zip Code

Day

Year

SECTION 4 CERTIFICATION AND SIGNATURE OF APPLICANT
If the wreckfish shareholder is not the vessel owner, the undersigned certifies and docum ents that the vessel own er
or op erato r is an em ploye e, con tracto r, or age nt of th e shareh olde r.
Sh areh olde r’s Sig natu re

Na m e (print)

Da te

Po sition , if ow ne r is a C orp ora tion /Pa rtne rsh ip

revised: 05/27/2004

GENERAL INSTRUCTIONS
For a person aboard a fishing vessel to fish for wreckfish in the exclusive economic zone (EEZ), possess wreckfish in or from the EEZ, off load wreckfish
from the EEZ, or sell wreckfish in or from the EEZ, a vessel permit for wreckfish must be issued to the vessel and be on board. An application for a vessel
permit for wreckfish must be submitted and signed by a wreckfish shareholder.
1.

Type or print legibly in ink. INCOMPLETE OR UNREADABLE APPLICATIONS WILL BE RETURNED.

2.

The fee is $50 for each permit application. The fee is non-refundable. All checks or money orders must be made payable to the
U.S. TREASURY.

3.

Mail the completed application, copy of the vessel's current certificate of documentation if documented with the Coast Guard or, if not documented,
the state registration certificate, and a check or money order for $50 to the: National Marine Fisheries Service (F/SER1), 263 13th
Avenue South, St. Petersburg, FL 33701.

4.

The Regional Director may require the wreckfish shareholder to provide documentation supporting the certification in Section 4. Such required
documentation may include copies of appropriate forms and schedules from the shareholder's income tax return; articles of incorporation for a
corporate-owned vessel; a partnership agreement for a partnership-owned vessel; a lease on a vessel for which a permit is requested; or an
employment or other contract, or agency agreement that demonstrates an agency, employment, or contract relationship between the wreckfish
shareholder and vessel owner or operator.

5.

If the permit is lost, a replacement may be obtained by writing to the above address. The fee is $18 for a replacement permit.

6.

Questions may be phoned to 727/824-5326 between 8:00am and 4:30pm, EST., Monday - Friday.

APPLICATION INSTRUCTIONS
Each section displays the required data elements. You must provide each data element as indicated in each section
SECTION 1

Vessel Name: The name of the vessel as shown on the Coast Guard certificate of documentation or state registration certificate.
Official Number (Coast Guard Documentation or State Registration Number): The vessel's U.S. Coast Guard certificate of
documentation number or, if not documented, the state registration certificate number.
Home Port: Place where you keep your vessel, not necessarily the home port shown on the Coast Guard documentation.
Vessel Length (ft.): The registered length as shown on the Coast Guard documentation or state registration certificate.

SECTION 2

Wreckfish Shareholder Federal ID Number: If the shareholder is a corporation or partnership, print the Federal employer
identification number.
Wreckfish Shareholder Date of Birth/Date Corporation Formed: If the shareholder is an individual, print the date of birth. If the
shareholder is a corporation or partnership, print the date (month/day/year) the corporation or partnership was formed.

SECTION 3

Owner's Name: Individual or corporate name of vessel owner as shown on the Coast Guard documentation or state
registration certificate.
Owner's Federal ID Number: If the owner is a corporation or partnership, print the Federal employer identification number.
Owner's Date of Birth/Date Corporation Formed: If the owner is an individual, print the date of birth. If the owner is a
corporation or partnership, print the date (month/day/year) the corporation or partnership was formed.

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including 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 suggestions for reducing this burden to Robert A. Sadler, National Marine Fisheries Service (F/SER1), 263
13th Avenue South, St. Petersburg, FL 33701. The National Marine Fisheries Service requires this information for the conservation and
m anagement of marine fis hery resources. The data reported will be used to develop, implement, and monitor fishery management activities for a
variety of other uses. Responses to this collection are required to obtain or retain a fisheries permit under the Magnuson - Stevens Act. The following
non-confidential information: Name, Street Address, City, State, Zipcode, Effective Date of Permit, Permit Types, Vessel Name, Vessel Identification
Number, and Passenger Capacity in the case of a "for hire" vessel for individual, corporate and lease holders of permits will be released via a NOAA
Fisheries website. All other data submitted will be handled as confidential material in accordance with NOAA Administrative Order 216-100,
Protection of Confidential Fishery Statistics. Notwithstanding any other provisisions of the law, no person is required to respond to, nor shall any
any person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction
Act, unless that collection of information displays a currently valid OMB Control Number.

KNOWINGLY SUPPLYING FALSE INFORMATION OR WILLFULLY OVERVALUING ANY FISHING INCOME FOR THE PURPOSE OF OBTAINING A
PERMIT IS A VIOLATION OF FEDERAL LAW PUNISHABLE BY A FINE AND/OR IMPRISONMENT.

Revised: 05/27/2004