Dealer Permit Application Form - Renewal

US DEPARTMENT OF COMMERCE
NATIONAL OCEANIC & ATMOSPHERIC ADMINISTRATION
NATIONAL MARINE FISHERIES SERVICE
55 GREAT REPUBLIC DRIVE
25 August 2009
GLOUCESTER, MA 01930-2276

2009 NORTHEAST FEDERAL FISHERIES DEALER PERMIT RENEWAL APPLICATION

Tel: (978) 281-9370

SECTION 1 - DEALER INFORMATION
Northeast Dealer Permit Number:
Company Name:
Owner's Name:
Company Address:

Southeast Dealer Permit Number:
______________________________
______________________________
______________________________
______________________________

_____________

Telephone:
** Vessel Name:

Fax Number:

_________________________

** Vessel Hull Number:

____________

_____________

______________________________
______________________________

** Must enter vessel name and hull number above if applying for Atlantic Mackerel At-sea Processor
permit or an Atlantic Herring At-sea processor permit.

Where there is more than one place of business where the regulated species are purchased or received for commerical purposes,
each address must be listed. List those additional addresses on the back of this form in Section 1A.
SECTION 2 -

FISHERIES

Select Desired Fisheries by Placing (X) in Spaces Provided:

Atlantic Bluefin Tuna

___

Other Atlantic Tunas (Yellowfin,
Bigeye, Skipjack, Albacore)

___

Surf Clam / Ocean Quahog - Dealer

___

Scup

___

Black Sea Bass

___

Monkfish

___

Bluefish

___

Atlantic Herring - Dealer

___

Atlantic Herring At Sea Processor

___

Spiny Dogfish

___

Tilefish

___

Red Crab

___

Skate

___

Atlantic Hagfish

___

Surf Clam / Ocean Quahog- Processor ___
Summer Flounder

___

Sea Scallop

___

Northeast Multispecies

___

American Lobster

___

Squid, Mackerel, Butterfish

___

Atlantic Mackerel At Sea Processor

___

SECTION 3 - APPLICANT'S SIGNATURE

Signature:_________________________________
I affirm subject to the penalties provided in 18 USC 1001,
that all information I have given in obtaining this permit Print Name:__________________________________
is true and correct.
Date:__________________________________

OMB NO. 0648-0202
Expires 11/30/2009
Public reporting burden for this collection of information is estimated to average 5 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining data
needed, and completing and reviewing the information. Send comments regarding this burden estimate or
suggestions for reducing this burden to: National Marine Fisheries Service, Permit Office, 55 Great
Republic Drive, Gloucester, MA 01930-2276.

SECTION 1A - ADDITIONAL DEALER INFORMATION. If there is more than one place
of business where the regulated species are purchased or received for
commercial purposes, each address must be listed below.
Company Address:
Street: ________________________________________________
City: ________________________________________________
State: ________________________ Zip: _________________
Company Telephone: (Area Code) _______ No. ____________________
Company Address:
Street: ________________________________________________
City: ________________________________________________
State: ________________________ Zip: _________________
Company Telephone: (Area Code) ________ No. ___________________
Company Address:
Street: ________________________________________________
City: ________________________________________________
State: ________________________ Zip: _________________
Company Telephone: (Area Code) ________ No. ___________________
Company Address:
Street: ________________________________________________
City: ________________________________________________
State: _________________________ Zip: ________________
Company Telephone: (Area Code) ________ No. ___________________

The information requested on this form is not confidential and will be available to the general public.
The Paperwork Reduction Act requires potential respondents for a dealer/processor permit be notified of
certain information regarding their rights and the burden associated with applying for a Federal
dealer/processor permit. One of the regulatory steps taken by the National Marine Fisheries Service (NMFS)
to carry out conservation and management objectives is the requirement of a permit for users of the
resources. All the fisheries included on this application require a permit to purchase, or otherwise
receive for transport, species harvested by the owner or operator of a fishing vessel issued a Federal
fisheries permit for these species. Section 303(b)(1) of the Magnuson Fishery Conservation and Management
Act (MFCMA) specifically recognizes the need for permit issuance.
The purpose and use of permits is to: (1) register fish dealers and processor, (2) list the characteristics
of dealer/processor operations, (3) exercise influence over compliance (e.g. withhold issuance pending
collection of unpaid penalties), (4) provide a mailing list for the dissemination of important information
to the industry, (5) provide a universe for data collection samples, and (6) obtain first purchase
information on landings to evaluate the biological, economic and social implications of management measures.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be
subject 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.