Permit Application for vessels fishing in the Exclusive

OMB No. 0648-0205

FEDERAL PERMIT APPLICATION FOR VESSELS
FISHING IN THE EEZ FOR SHRIMP

Form Approval Expires: 10/31/06

U.S. DEPARTMENT OF COMMERCE

FOR OFFICE USE ONLY

NOAA FISHERIES PERMITS BRANCH, F/SER1

Check/money order #:

263 13th Avenue South
St. Petersburg, FL 33701

Reviewer's Initials/Date:

727/824-5326 (8 am - 4:30 pm ET)
Violation Date:

http://sero.nmfs.noaa.gov

Violation Cleared Date:
Expiration Date:

VESSEL INSTRUCTIONS
1. In filling out the information below, most applicable vessel/gear information can be found on the U.S. Coast
Guard Documentation or state registration for the vessel. A current copy of the Coast Guard Documentation or if
not documented a current copy of the state registration must be provided.
2. The application fee is $50for th efirst permit, $20 for each additional permit. A non-refundable check or money
order made payable to the U. S. Treasury must accompany the application.
3. Please print legibly or type. An incomplete or illegible application will be returned.
PERMITS APPLIED FOR
Gulf of Mexico Shrimp Permit

Gulf of Mexico Royal Red Shrimp Endorsement to the Gulf of Mexico Shrimp Permit.

South Atlantic Open Access Pinnead Shrimp Permit (does not include South Atlantic Rock Shrimp or South Atlantic Rock Shrimp Limited Entry
area endorsement)

VESSEL AND GEAR INFORMATION

CG Doc or State Registration No.
(official number)

Year Built

Hull Material

Length (ft)

Fuel Type

Vessel Name

Horsepower

Fuel Capacity
(gallons only)

How do you store your shrimp on board your vessel
(Freezer or Ice)

Hull ID Number

Gross tons

Net tons

Homeport City

Fish Hold Capacity (tons; not pounds)

Homeport State

How do you harvest your shrimp?
(Shrimp Trawl or other type of harvesting gear)

Form Revised: 08/16/2005

VESSEL OWNER/LESSEE INSTRUCTIONS
1. Enter the information of the person shown as the "owner" on the vessel's Coast Guard Documentation or, if not documented, on the
state registration certificate. If the person shown as the
"owner" is a corporation or partnership, enter the Federal ID number and date
the corporation was formed or partnership was filed. If the owner is an individual, enter the Social Security Number. If the vessel is
corporately owned, a copy of the Active Articles of Incorporation (for new owners) and a copy of the most current annual business report
must be submitted. An inactive corporation will not be issued a permit.
2. By placing an "X" in the Mailing Recipient block, this indicates who you select to receive the permit and all related information.
3. If the vessel is being operated under a lease or other written management agreement that bestows control over the destination,
function or operation of the vessel to a person other than the vessel owner (i.e., as stated on the Coast Guard Documentation or state
registration), you must submit information on each lessee, as well as a copy of current lease agreement with beginning and ending
dates. If such lease or written management agreement exists, the lessee is the owner for the purposes of the permit. The lease must be
signed by all parties.

Mailing Recipient
Check one

Relationship (owner or lessee):
Last Name

First Name

Mailing Address

Federal ID #

Individual

Middle Name

City

SSN

Prefix Name

State

Date of Birth/Corp. filed

Phone

Business
Suffix Name

County

Zip Code

Lease Start Date

Country

Lease Expiration Date

Mailing Recipient
Check on

Relationship (owner or lessee):
Last Name

First Name

Mailing Address

Federal ID #

Middle Name

City

SSN

Individual

Prefix Name

State

Date of Birth/Corp. filed

Phone

Business
Suffix Name

County

Lease Start Date

Zip Code

Country

Lease Expiration Date

SIGNATURE (The application must be signed and dated.)
The undersigned certifies that he/she meets all applicable requirements for the requested permit.

Owner's/Lessee's/Shareholder's Signature

Position (if owner/lessee is a business or partnership)

Date

Officer/Shareholder Information
Company name
Owner or lessee for vessel:

Business ID (Office use only):

Federal ID #
1. All individuals associated with the above-named company must be included in this application. Attach
additional sheets as necessary to list all officers, directors, shareholders, and registered agents of the
corporation. Provide names, addresses, phone number, date of birth, and position held in corporation.
Position held in company

Mr. / Mrs. / Ms.

Last Name

BusinessID # (office use only)

First Name

Street

Middle Name

Area Code/Telephone

City

County

State

Position held in company

Mr. / Mrs. / Ms.

Last Name

First Name

Middle Name

Area Code/Telephone

City

County

State

Position held in company

Last Name

Date of Birth

Zip Code

Suffix name (e.g. Jr.,
Sr., III, etc.)

SSN

Date of Birth

BusinessID # (office use only)

First Name

Street

City

SSN

BusinessID # (office use only)

Street

Mr. / Mrs. / Ms.

Zip Code

Suffix name (e.g. Jr.,
Sr., III, etc.)

Middle Name

Area Code/Telephone

County

State

Zip Code

Suffix name (e.g. Jr.,
Sr., III, etc.)

SSN

Date of Birth