Form 3-186 Notice of Transfer or Sale of Migratory Waterfowl

USFWS Use Only

DEPARTMENT OF THE INTERIOR
U.S. Fish and Wildlife Service
Form 3-186

Date Received
______/_____/_____

Initials:

NOTICE OF TRANSFER OR SALE OF MIGRATORY WATERFOWL
SENDER (Permittee)
Name

Permit Number:_____________

RECIPIENT
Name

Address

Address

City

State

Phone Number: (

)

Zip Code
-

E-mail Address:

City

State

Phone Number: (

)

Zip Code
-

E-mail Address:

DATE OF SHIPMENT:

METHOD OF MARKING (excluding eggs):
BIRDS AND/OR EGGS TRANSFERRED
Number of
Males Females Eggs
Species

Species

Number of
Males
Females

Eggs

I certify that the information submitted above is true and correct to the best of my knowledge. I understand that making a false statement may
subject me to the criminal penalties of 18 U.S.C. 1001.

_______________________________________ _______________
Permittee’s Signature (in blue ink)
Date
Form 3-186

________________________________ ____________
Recipient’s Signature (in blue ink)
Date

Rev12/2013

OMB Control No. 1018-0022 Expires XXXXXX

Instructions for Completing Form 3-186
If you are...
selling, trading, or giving
away migratory waterfowl
directly to the recipient,

then you need to do the following:
1.
2.
3.
4.
5.

conducting your
transaction by mail,

1.
2.

3.
4.

You (the seller) must complete all sections of the form and sign the certification, even if you
are giving the birds or eggs as a gift.
Make sure that the recipient of the birds or eggs (whether buying them or receiving them as a
gift) signs the certification.
Give the recipient the original copy of the completed form.
Retain one copy as your record of the transaction.
Mail one copy to the Regional FWS Migratory Bird Permit Office responsible for your State
before the end of the month in which you transfer the birds or eggs.
You (the seller) must complete all sections of the form and sign the certification, even if you
are giving the birds or eggs as a gift.
Send the completed form to the recipient of the birds or eggs (whether buying them or
receiving them as a gift) on the date the birds are shipped.
a. Have the recipient sign the certification.
b. Have the recipient keep the original copy and return a copy to you.
Retain one copy as your record of the transaction.
Mail one copy to the Regional FWS Migratory Bird Permit Office responsible for your State
before the end of the month in which you transfer the birds or eggs.
Notice

Privacy Act (5 U.S.C.552a): The gathering of information on fish and wildlife is authorized by the Migratory Bird Treaty Act (16 U.S.C. 703 et seq.), and Parts
13 and 21 of Title 50 of the Code of Federal Regulations. Disclosure of the requested information is necessary for administration of permits under MBTA and is a
condition of your permit. Failure to disclose all of the requested information may be sufficient cause for revocation of your permit. The information will be used
to monitor take and disposition of migratory birds. If the information indicates a violation of a statute, regulation, rule, order, or license, whether civil, criminal,
or regulatory in nature, the information may be transferred to the appropriate Federal, State, local, or foreign agency charged with investigating or prosecuting
such violations. (Ref. 69 FR 5261, Sept 4, 2003) Paperwork Reduction Act (44 U.S.C.3501): An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control number. The reporting burden estimate for reviewing instructions,
gathering and maintaining data, and completing this form is 15 minutes. Direct comments regarding the burden estimate or any other aspect of the form to the
Information Collection Clearance Officer (1018-0022), Mail Stop 222-ARLSQ, Fish & Wildlife Service, U.S. Department of the Interior, 1849 C Street, NW
Washington, D.C. 20240.

Migratory Bird Regional Permit
Offices
FWS
REGION

AREA OF
RESPONSIBILITY

MAILING
ADDRESS

CONTACT
INFORMATION

Region 1

Hawaii, Idaho, Oregon,
Washington

911 N.E. 11th Avenue
Portland, OR 97232-4181

Tel. (503) 872-2715
Fax (503) 231-2019
Email [email protected]

Region 2

Arizona, New Mexico,
Oklahoma, Texas

P.O. Box 709
Albuquerque, NM 87103

Tel. (505) 248-7882
Fax (505) 248-7885
Email [email protected]

Iowa, Illinois, Indiana,
Minnesota, Missouri,
Michigan, Ohio, Wisconsin

5600 American Blvd. West
Suite 990
Bloomington, MN
55437-1458
(Effective 5/31/2011)

Tel. (612) 713-5436
Fax (612) 713-5393
Email [email protected]

Alabama, Arkansas, Florida,
Georgia, Kentucky, Louisiana,
Mississippi, North Carolina,
South Carolina, Tennessee,
Virgin Islands, Puerto Rico

P.O. Box 49208
Atlanta, GA 30359

Tel. (404) 679-7070
Fax (404) 679-4180
Email [email protected]

Region 3

Region 4

Connecticut, District of
Columbia, Delaware, Maine,
Maryland, Massachusetts,
New Hampshire, New Jersey,
New York, Pennsylvania,
Rhode Island, Virginia,
Vermont, West Virginia

P.O. Box 779
Hadley, MA 01035-0779

Tel. (413) 253-8643
Fax (413) 253-8424
Email [email protected]

Region 6

Colorado, Kansas, Montana,
North Dakota, Nebraska,
South Dakota, Utah, Wyoming

P.O. Box 25486
DFC(60154)
Denver, CO 80225-0486

Tel. (303) 236-8171
Fax (303) 236-8017
Email [email protected]

Region 7

Alaska

1011 E. Tudor Road
(MS-201)
Anchorage, AK 99503

Tel. (907) 786-3693
Fax (907) 786-3641
Email [email protected]

Region 8

California, Nevada

2800 Cottage Way
Room W-2606
Sacramento, CA 95825

Tel. (916) 978-6183
Fax (916) 414-6486
[email protected]

Region 5