Vessels fishing in the EEZ application

0MB No. 0648-0205 Form Approval Expires: 10/31/2014

U.S. Department of Commerce, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13th Avenue South
St. Petersburg, FL 33701
Toll Free 877-376-4877 (8:00 am. 4:30 p.m. ET)
727-824-5326 (8:00 am. 4:30 p.m. ET)
Permits. se ro. n mfs. noaa gov

FEDERAL PERMIT APPLICATION FOR
VESSELS FISHING IN THE EXCLUSIVE
6.

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ECONOMIC ZONE (EEZ)

c
‘‘4res 0

FOR OFFICE USE ONLY

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Reviewer’s Initials and Date
Permit Check or Money Order
Number and Amount
Floy Tag Check or Money Order
Number and Amount
Sanctioned Case Number if
Sanctioned
Non Compliance Hold Date
FOR OFFICE USE ONLY

Non Compliance Cleared Date

Application ID
Expiration Date(s)

REMEMBER TO SEND A COPY of the current (not expired) United States Coast Guard (USCG) Certificate of Documentation or a copy
of the State Vessel Registration. Do not send the original. If the vessel’s state registration does not list all owners, also provide a copy
of the vessels title, or other documentation from the appropriate state agency, that identifies all vessel owners.
SECTION 1

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VESSEL INFORMATION

Official Number From USCG Certificate Of

Documentation (If the vessel is documented)

Length (ft)

Year Built

Total Horsepower

State Registration Number (as applicable)
Crew Size—Including the Captain
Vessel Name

HOLD or FISH BOX CAPACITY
How many pounds of product can you bring
to the dock when full?

Hull Identification or IMO Number
Hull Material
Hailing Port City

Hailing Port County Or Parish

Hailing Port State

Product Storage
(check all that
apply)

Fuel Data

FIBERGLASS

DIESEL

STEEL

GASOLINE

WOOD

OTHER
(DESCRI BE)

D

ON ICE IN
HOLD, FISH
BOX, ICE
CHEST,
COOLER,
ETC

CEMENT

FREEZER
OTHER

USCG DOCUMENTED VESSELS ONLY
Gross Tons

(DESCRIBE)

Net Tons

Passenger Capacity Data For Charter
Vessels/Headboats Only

This vessel is
used MOSTLY for
(select only one)

UNISPECTED VESSEL- “6-PACK”

Commercial
Fishing

USCG INSPECTED VESSEL: specify
Passenger Capacity as Ii5ted on the USCG

H Certificate of Inspection, not including Capt.

Charter

and Crew.

Headboat

Fuel Capacity
Total Gallons

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LIVE WELL

H

For Shark and Swordfish Directed and
Incidental Permit Applicants Only: Does your
vessel fish with, or carry onboard, either
Iongline or gillnet gear?

D

Yes

D

No

Reminder: If yes, include a copy of your
“Protected Species Release,
Disentanglement, and Identification
Workshop Certificate”.
Form Revision 12DEC2013

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SECTION 2

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OPEN ACCESS PERMITS AND ENDORSEMENTS

Payment Reminder: All applications must include payment of a non-refundable application fee in the form of a check or money order
made payable to the U.S. Treasury. The fee is $25.00 for the first permit and $10.00 for each additional permit or endorsement
requested on this application.
FEE SCHEDULE FOR PERMITS AND ENDORSEMENTS:
1 Permit: $25

2: $35

3: $45

4: $55

5: $65

6: $75

7: $85

8: $95

9: $105

10: $115

11: $125

12: $135

INSTRUCTIONS: Find the permits in the left column and mark the check box beside that fishery to indicate what transaction(s) you want.

OPEN ACCESS COMMERCIAL PERMITS

NEW

RENEW

ATLANTIC DOLPHIN/WAHOO (ADW)
SPINY LOBSTER (LC) (Not required for the EEZ off Florida)
SPINY LOBSTER TAILING (LT) You must have an LC permit OR provide your FLSPL information below.

SPANISH MACKEREL (SM)
ROCK SHRIMP CAROLINAS ZONE
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SOUTH ATLANTIC PENAEID SHRIMP (SPA)
GULF ROYAL RED SHRIMP ENDORSEMENT (GRRS) You must have a valid Gulf of Mexico Shrimp permit
HMS COMMERCIAL CARIBBEAN SMALL BOAT PERMIT (CCSB(

FOR LOBSTER TAILING PERMIT APPLICANTS ONLY
LOBSTER TAILING APPLICANTS: To obtain a lobster tailing permit you must possess a Florida Saltwater Products License (SPL) with
Restricted Species and Crawfish endorsements. If you do not have a Florida SPL with Restricted Species and Crawfish Endorsements, you
must possess or simultaneously obtain a valid Federal Spiny Lobster (LC) permit.

You must provide a copy of your Florida SPL if you do not have a Federal Spiny Lobster (LC) permit
Saltwater Products License Number

Crawfish Endorsement Number

Saltwater Products License
Expiration Date

OPEN ACCESS CHARTER/HEADBOAT PERMITS

NEW

ATLANTIC CHARTER/HEADBOAT FOR DOLPHIN/WAHOO (CDW(
ATLANTIC CHARTER/HEADBOAT FOR COASTAL MIGRATORY PELAGICS (CHS)
SOUTH ATLANTIC CHARTER/HEADBOAT FOR SNAPPER-GROUPER (SC)

2

RENEW

SECTION 3

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LIMITED ACCESS/MORATORIUM PERMITS AND ENDORSEMENTS

Payment Reminder: All applications must include payment of a non-refundable application fee in the form of a check or money order
made payable to the U.S. Treasury. Please refer to the fee schedule in section 2 of the application.,
INSTRUCTIONS: Find the permits in the left column and mark the check box beside that fishery to indicate what transaction(s) you want.

LIMITED ACCESS COMMERCIAL PERMITS

TRANSFER

RENEW

KING MACKEREL (KM)
GILLNET FOR KING MACKEREL (GN)
GULF OF MEXICO SHRIMP (SPGM)
GULF OF MEXICO COMMERCIAL REEF FISH (RR)
EASTERN GULF OF MEXICO REEF FISH BOTTOM LONG LINE ENDORSEMENT (RRLE)
ROCK SHRIMP (SOUTH ATLANTIC EEZ) (RSLA)
SOUTH ATLANTIC GOLDEN CRAB (GC)
SOUTH ATLANTIC UNLIMITED SNAPPER-GROUPER (EXCLUDING WRECKFISH) (SG1)
SOUTH ATLANTIC 225 LB TRIP LIMIT SNAPPER-GROUPER (EXCLUDING WRECKFISH) (SG2)
SOUTH ATLANTIC SEA BASS POT ENDORSEMENT (SBPE)
SOUTH ATLANTIC GOLDEN TILEFISH ENDORSEMENT (GTFE)
SWORDFISH DIRECTED (SFD)
SWORDFISH HANDGEAR (SFH)
SWORDFISH INCIDENTAL (SF1)
SHARK DIRECTED (SKD)
SHARK INCIDENTAL (SKI)
ATLANTIC TUNA LONGLINE (ATL) Must have either SF1 or SKI and either SFD or SKD

LIMITED ACCESS CHARTER/HEADBOAT PERMITS

TRANSFER

RENEW

GULF CHARTER/HEADBOAT FOR COASTAL MIGRATORY PELAGIC FISH (CHG)
GULF CHARTER/HEADBOAT FOR REEF FISH (RCG)
HISTORICAL CAPTAIN GULF CHARTER/HEADBOAT FOR COASTAL MIGRATORY PELAGIC FISH (HCHG)
HISTORICAL CAPTAIN GULF CHARTER/HEADBOAT FOR REEF FISH (HRCG)

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SECTION 4

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INDIVIDUAL VESSEL OWNER(S) AND LESSEE INFORMATION

Answer all of the following questions to see how to fill out this section. Copy this page as needed to provide the required information
on all persons that own or lease the vessel.
Does your USCG Documentation or State Registration
show the vessel owner as a person or persons?

YES Use this page for the
[yel owners

NO Fill out vessel owner
info in Section 5

Does your USCG Documentation or State Registration
show more than one person as the vessel owner?

YES Use Section 4a and 4b
for the vessel owners

NO Fill Out Section 4b if
vessel is leased

Is a person or persons leasing this vessel from the vessel
owner?

YES Use Section 4b for the
lessee

NO The lessee iso business
Put lessee info in Section Sb

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NO Skip Section 4b
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SECTION 4a Vessel Owner on the USCG Certificate of Documentation or State Registration for Undocumented Vessels
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1) If the USCG Documentation or State Registration shows one person as sole vessel owner

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list their information here.

2) If the USCG Documentation or State Registration shows more than one person as vessel owner
and 4b.

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list their information in Sections 4a

3) If there are more than two persons, photocopy this blank page as necessary to provide information for all the owners.

MAILING RECIPIENT All mail about this permit will go to the person listed in Section 4a
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Is this person a United States Citizen or permanent resident alien?
Mr/Mrs/Ms

Last Name

YES

NO

First Name

Middle Name

Date of Birth (MM/DD/YYYY)

Area Code

Suffix ir, Sr, etc.
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If you are operating under a different name,
what is your Doing Business As (DBA) name?
Tax Identification Number (SSN)

Mailing Address

Apt #

City

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish

Zip Code

Country

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

Apt #

City

SECTION 4b Vessel Lessee OR Joint Vessel Owner on the USCG Certificate of Documentation or State Registration
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1) If the USCG Documentation or State Registration shows more than one person as sole vessel owner

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list their information here.

2) If this vessel is leased by a person(s), list the lessee’s information here.
3) If there are more than two people, photocopy this blank page as necessary to provide information for all the owners and lessee’s.

Lease start date:

Lease end date:

MAILING RECIPIENT All mail about this permit will go to the person listed in Section 4a
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Is this person a United States Citizen or permanent resident alien?
Mr/Mrs/Ms

Last Name

First Name

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Tax Identification Number (SSN)

YES

NO
Middle Name

Suffix ir, Sr, etc.
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r
Date of Birth (MM/DD/YYYY)

Area Code

Phone Number

H____________________
Mailing Address

Apt #

City

State

County/Parish

Zip Code

Country

State

County/Parish

Zip Code

Country

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

Apt #

City

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SECTION 5

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BUSINESS VESSEL OWNER(S) AND LESSEE INFORMATION

Answer all of the following questions to see how to fill out this section. Copy this page as needed to provide the required information
on all persons that own or lease the vessel,
Does your USCG Documentation or State Registration
show the vessel owner as a business?

YES Use this page for the
vessel owners

NO Fill out previous page
for vessel owners

Does your USCG Documentation or State Registration
show more than one business as the vessel owner?

YES Use Sections 5a and
Sb for the vessel owners

NO Fill out Section 5b if
vessel is leased

Is a business or businesses leasing this vessel from the
vessel owner?

YES- Use Section 5b for the

NO

SECTION 5a

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lessee

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The lessee iso person
Put lessee info in Section 4b
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NO Skip Section 5b
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Vessel Owner on the USCG Certificate of Documentation or State Registration for Undocumented Vessels

1) If the USCG Documentation or State Registration shows one business as sole vessel owner list their information in Section 5a.
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2) If the USCG Documentation or State Registration shows multiple businesses as vessel owner
5b.

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list their information in Sections Sa and

3) If there are more than two businesses, photocopy this blank page as necessary to provide information for all the owners.
MAILING RECIPIENT All mail about this permit will go to the person listed in Section 5a
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Is this business entity established under the laws of the United States or any State of the United States?

YES

NO

Registered Name of Business

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Tax Identification Number (FEIN)

Mailing Address

Date Business Formed (MM/DD/YYYY)

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish

Zip Code

Country

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

Apt #

City

SECTION 5b Vessel Lessee OR Joint Vessel Owner on the USCG Certificate of Documentation or State Registration
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1) If the USCG Documentation or State Registration shows more than one business as sole vessel owner

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list their information here.

2) If this vessel is leased by a business(es), list the lessee’s information here.
3) If there are more than two businesses, photocopy this blank page as necessary to provide information for all owners and lessee’s.
Lease start date:

Lease end date:

MAILING RECIPIENT All mail about this permit will go to the person listed in Section 5b
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Is this business entity established under the laws of the United States or any State of the United States?

YES

NO

Registered Name of Business

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Tax Identification Number (FEIN)

Mailing Address

Date Business Formed (MM/DD/YYYY)

Apt It

City

Area Code

State

H

Phone Number

County/Parish

H

Zip Code

H

Country

1

H

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

Apt It

City

State

5

County/Parish

Zip Code

Country

SECTION 6

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OFFICER/SHAREHOLDER INFORMATION FOR BUSINESS(ES) THAT OWN OR LEASE THE VESSEL

This page must be filled out if the owner or the lessee of the vessel is a business. Copy this page as necessary to provide information on
all persons that are officers/shareholders of the business(es) shown in Section 5.
Owner or lessee of the vessel:

Owner

Lessee

Business name
Position Held

Federal Tax ID Number

-

Check ALL That Apply

President/CEO

Vice President

Treasurer

Director/ Manager

Shareholder

Last Name

Tax Identification Number (SSN)

First Name

Middle Name

Date of Birth (MM/DD/YYYY)

Area Code

Other
YES

Is this business entity a United States citizen or permanent resident alien?

Percent of Corporation Held
Mr/Mrs/Ms

Secretary

NO

Suffix -ir, Sr, etc.

Phone Number

H
Mailing Address

City

Apt It

State

County/Parish

Zip Code

Country

State

County/Parish

Zip Code

Country

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

City

Apt It

Position Held Check ALL That Apply
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President/CEO

Vice President

Percent of Corporation Held
Mr/Mrs/Ms

Secretary

Treasurer

Director/ Manager

Shareholder

YES

Is this business entity a United States citizen or permanent resident alien?

Last Name

Tax Identification Number (SSN)

First Name

Middle Name

Date of Birth (MM/DD/YYYY)

Area Code

City

Apt It

Mailing Address

Other
NO

Suffix ir, Sr, etc.
-

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish

Zip Code

Country

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

City

Apt It

H

H

H

H

H

H

Minor Shareholder Information
MINOR SHAREHOLDERS

-

Check here if one or more shareholders individually holds shares that is less than 1% of the total business shares,

TOTAL PERCENTAGE of the business shares held by minor shareholderls)

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SECTION 7

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HISTORICAL CAPTAIN OR DESIGNATED OPERATOR (INCOME QUALIFIER)

This person is a (check all that apply):
Historical Captain for Gulf of Mexico Charter/Headboat for Reef fish
Historical Captain for Gulf of Mexico Charter/Headboat for Coastal Migratory Pelagic fHsh
Designated Operator (Income Qualifier other than the Permit Holder) for:
Check all that apply:

Commercial King Mackerel

Commercial Spiny Lobster

Spanish Mackerel

A Historical Captain MUST sign Section 9os the applicant.
A Designated Operator MUST sign Section 9 as the operator along with the applicant.
Mr/Mrs/Ms

Last Name

Tax Identification Number (SSN)

First Name

Middle Name

Date of Birth (MM/DD/YYYY)

Area Code

Mailing Address

Apt #

City

State

Suffix ir, Sr, etc.
-

Phone Number

County/Parish

Zip Code

H

Country

H_______

Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)

Apt #

City

State

County/Parish

II H

Zip Code

H

Country

H________

SECTION 8 SEA BASS POTS OR GOLDEN CRAB TRAPS
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COMPLETE THIS SECTION ONLY IF YOU HAVE SEA BASS POTS OR IF YOU HAVE GOLDEN CRAB TRAPS. TAGS ARE REQUIRED
FOR ALL POTS/TRAPS
Tag cost is $1.80 per tag made payable by check or money order to Flay Tag, Inc.
I need tags for:

Sea Bass Pots

Golden Crap Traps

What color are your Buoys for Sea Bass Pots or Golden Crab Traps?
List an existing buoy color code for ANY other trap or pot fishery?
South Atlantic Sea Bass Pot/Golden Crab Trap Information You are allowed a MAXIMUM of 35 Sea Bass Pots
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Number of
Pots/Traps

Pot or Trap Height
(inches)

Pot or Trap Length
(inches)

Pot or Trap Width
(inches)

7

Mesh Size Height
(inches)

Mesh Size Width
(inches)

SECTION 9 SIGNATURE FOR APPLICATION REQUIRED
The undersigned certifies under penalty of perjury that the foregoing information is true and correct (28 usc 1746; 18 usc
1621; 18 usc i.ooi, 16 usc 1857). Further, the undersigned certifies that if a spiny lobster tailing permit is requested, the
applicant routinely fishes commercially in Federal waters on trips of up to 48 hours or more and that such fishing activity
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requires the separation of the tail and carapace to maintain quality product.

Please note: If the vessel listed in Section 1 is leased, the applicant who signs below must be an individual named as a
lessee in Section 4, or an officer or shareholder of the lessee as listed in Section 5 with information listed in section 6. If
the vessel listed in Section 1 is not leased, the applicant must be an individual named as an owner in Section 4, or an

officer or shareholder of the owner as listed in 5ection 6.

]

Applicant Signature

7J

Print Name

[

Position in Business

]Date

Designated Operator
Signature

]Date

SECTION 10 INCOME QUALIFICATION AFFIDAVIT FOR INCOME QUALIFIED PERMITS
An Income Qualification Affidavit is accepted as proof of meeting permit income qualification requirements. This signed
Income Qualification Affidavit is required with every application to renew or transfer an income qualified permit (as listed
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below).

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.
Spiny Lobster

King Mackerel

Spanish Mackerel

50cFR622.400 An applicant
must provide the following
information: (vi) A sworn statement
by the applicant for a vessel permit
certifying that at least 10 percent of
his or her earned income was
derived from commercial fishing,
that is, sale of the catch, during the
calendar year preceding the
application.

50CFR622.370 To obtain or
renew a commercial vessel permit
for king mackerel, at least 25
percent of the applicant’s earned
income, or at least $10,000, must
have been derived from commercial
fishing (i.e., harvest and first sale of
fish) or from charter fishing during
one of the 3 calendar years
preceding the application.

50CFR622.370 To obtain or
renew a commercial vessel permit
for Spanish mackerel, at least 25
percent of the applicant’s earned
income, or at least $10,000, must
have been derived from commercial

fishing (i.e., harvest and first sale of
fish) or from charter fishing during
one of the 3 calendar years
preceding the application.

The following information applies to my income qualification for the following fisheries:

check all that apply:

Spiny Lobster

King Mackerel

I,

,

information is true and correct (28

usc 1746;

18

Spanish Mackerel

hereby declare under penalty of perjury that the foregoing

usc 1621;

18

usc 1001;

16

usc 1857). I agree to provide the necessary

documentation to prove that I met the earned income requirement when so requested by the National Marine Fisheries
Service.
Executed on

(date signed).

Printed Name

Signature

Business Name (if Applicable)
Type of business (if Applicable)

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Position In Business (if Applicable)

Public reporting burden for thin 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: PRA Officer, National Marine Fisheries Service, F/SER26, 263 13th Avenue South, St. Petersburg, FL 33701.
The Nacional Marine Fisheries Service requires thin ,nformation 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 hsheries permit under the
Magnuson Stevens Act. Name and address information will be released via a NOAA website. All other data submitted will be handled as confidential material in accordance
with NOAA Administrative Order 216-100, Protection of confidential Fishery Statiutics. Notwithstanding any other provisions of the law, no person is required to respond to,
nor shall any person be nubiected to a penalty for failure to comply with, a collection of information subiect to the requirements of the Paperwork Reduction Act, unless that
collection of information displays a currently valid 0MB Control Number.
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