Federal Permit Application for Southeast Region Vessel O

FEDERAL APPLICATION FOR
SOUTHEAST REGION ISSUED
OPERATOR CARD

U.S. DEPT OF COMMERCE, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13th Avenue South
St. Petersburg, FL 33701-5505

REQUIRED FOR ATLANTIC DOLPHIN/WAHOO
AND/OR SOUTH ATLANTIC ROCK SHRIMP

727/824-5326 (8 am - 4:30 pm ET)
1-877-376-4877 Toll Free

OMB No. 0648-0205 Form Approval Expires: 10/31/2014

Reviewer's Initials
and Date:
Check or Money
Order Number:
Expiration Date:

http://sero.nmfs.noaa.gov

FOR OFFICE USE ONLY
FEE: $50.00
REPLACEMENT CARD: $18.00

Application ID

Make check or money order
payable to U.S. Treasury
Application Fees are
Non-Refundable

FOR OFFICE USE ONLY

GENERAL INSTRUCTIONS: (1) Operator cards are required by either the operator OR a crewmember of a commercial vessel or charter vessel/headboat
fishing for Atlantic Dolphin and/or Wahoo and/or South Atlantic Rock Shrimp. Atlantic Dolphin/Wahoo permits and South Atlantic Rock Shrimp Permits are not
valid unless the operator or a crewmember holds a valid Operator card when underway fishing for Dolphin, Wahoo and/or Rock Shrimp in the Atlantic EEZ.
(2) Applications must be legible; illegible applications will be returned. Application Fee is payable to the U.S. TREASURY by check or money order and is
Non- Refundable. FAILURE TO COMPLY WITH THESE INSTRUCTIONS MAY RESULT IN DELAY OR DENIAL OF AN OPERATOR CARD.
APPLICATION INSTRUCTIONS: All blanks in Section 1 must be filled in. Use Section 2 only if you have a mailing address that is different from the street
address required in Section 1. Information is required for all categories in Section 3, including your telephone number. Please list a number where you can
be reached or a message left for you if we have any questions. You must provide your federal tax identification number (SSN). You must provide two (2)
recent (less than 1 year old) passport style photos in 2 inch X 2 inch size. The photos must have a plain white background and your face must be
unobstructed by sunglasses, hats, scarves, etc. Vision correcting glasses are permitted. Do not staple, glue, tape, paperclip or otherwise attach the photos
to the application.

SECTION 1 - VESSEL OPERATOR (CARD OWNER) INFORMATION
LAST NAME

FIRST NAME

MIDDLE NAME

Suffix (Sr., Jr. II, etc)

STREET ADDRESS (NO POST OFFICE BOX ADDRESSES WILL BE ACCEPTED)

CITY

STATE

COUNTY

ZIP CODE

AREA CODE

COUNTRY

TELEPHONE NUMBER

SECTION 2 - MAILING ADDRESS - ONLY IF DIFFERENT FROM STREET ADDRESS GIVEN IN SECTION 1
MAILING ADDRESS

CITY

STATE

COUNTY

ZIP CODE

COUNTRY

SECTION 3 - IDENTIFYING INFORMATION
DATE OF BIRTH (MM/DD/YYYY)

SEX

Tax ID # (SSN)

BIRTH PLACE (CITY, STATE, COUNTRY)

HAIR COLOR

EYE COLOR

MALE

BROWN

GREEN

BROWN

BLONDE

FEMALE

BLUE

HAZEL

BLACK

RED

GREY

Other

GREY

Other
________

WHITE

If you are
clean shaven
or balding,
indicate your
actual hair
color

WEIGHT (LBS)

HEIGHT (FEET - INCHES)

________

SECTION 4 - SIGNATURE
Applicant Signature

Print Name

Date

Last Form Revision 12/18/2012

Public reporting burden for this collection of information is estimated to average 25 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 PRA Officer, National Marine Fisheries Service, F/SER2, 263 13th Avenue South,
St. Petersburg, FL 33701.
The National Marine Fisheries Service requires this information for the conservation and management of marine fishery
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. Confidential name and address information 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 provisions of the law, no person is required to respond to, nor
shall 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.