Dealer Report for Landing and Sale

OMB Control No. 0648-0703

Expiration Date:

DEALER REPORT FOR LANDING AND SALE OF CULTURED FISH

This form must be received by NOAA Fisheries within 24 hours of landing and sale. Use a new form for each separate transaction.

Form must be faxed to: (727) XXX-XXXX or submitted via web form (website TBD).

FOR OFFICE USE ONLY
Date Received
Gulf Aquaculture Permit Number
Reviewer Initials and Date

Part 1 – Dealer Information

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

( ) -

( ) -

HOME TELEPHONE NUMBER CELL PHONE NUMBER DEALER PERMIT NUMBER

BUSINESS NAME BUSINESS PHONE NUMBER

( ) -

Part 2 – Seller Information (Gulf Aquaculture Permit Holder)

NAME OF SELLER GULF AQUACULTURE PERMIT NUMBER

BUSINESS NAME BUSINESS PHONE NUMBER

( ) -

Part 3 – Landing Information

LOCATION (CITY, STATE) OF PORT¹ DATE OF LANDING (MM/DD/YYYY)

/ /

TIME OF LANDING² DEALER VESSEL DOCUMENTATION #

: A.M / P.M.

Part 4 – Transaction Information

Provide the following information for each species purchased from the vessel listed in Part 2. Report the estimated average weight for each species to the nearest tenth of a pound.

Species #1

SCIENTIFIC NAME (GENUS AND SPECIES) TOTAL WHOLE WEIGHT (LBS) EST. AVERAGE WHOLE WEIGHT (LBS)

TOTAL PRICE PAID AVERAGE PRICE PAID PER POUND NOTES

$

$

Species #2

SCIENTIFIC NAME (GENUS AND SPECIES) TOTAL WHOLE WEIGHT (LBS) EST. AVERAGE WHOLE WEIGHT (LBS)

TOTAL PRICE PAID AVERAGE PRICE PAID PER POUND NOTES

$

$

Species #3

SCIENTIFIC NAME (GENUS AND SPECIES) TOTAL WHOLE WEIGHT (LBS) EST. AVERAGE WHOLE WEIGHT (LBS)

TOTAL PRICE PAID AVERAGE PRICE PAID PER POUND NOTES

$

$

Species #4

SCIENTIFIC NAME (GENUS AND SPECIES) TOTAL WHOLE WEIGHT (LBS) EST. AVERAGE WHOLE WEIGHT (LBS)

TOTAL PRICE PAID AVERAGE PRICE PAID PER POUND NOTES

$

$

Species #5

SCIENTIFIC NAME (GENUS AND SPECIES) TOTAL WHOLE WEIGHT (LBS) EST. AVERAGE WHOLE WEIGHT (LBS)

TOTAL PRICE PAID AVERAGE PRICE PAID PER POUND NOTES

$

$

Dealers must maintain sales records for at least 3 years after the receipt date. Records must be made available for inspection by NOAA Fisheries personnel or authorized officers upon request.

Part 5 – Signature

I hereby declare under penalty of perjury that the foregoing information is true and correct (28 U.S.C. section 1746; 18 U.S.C. section 1621; 18 U.S.C. section 1001).

DEALER SIGNATURE PRINTED NAME DATE SIGNED (MM/DD/YYYY)

Public reporting burden for this collection of information is estimated to average 30 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 other suggestions for reducing this burden to PRA Officer, National Marine Fisheries Service. F/SER26, 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. Non-confidential information may be released via a NOAA Fisheries website. Non-confidential information means: Name, Street Address, City, State, Zip Code, Effective Date of Permit, Permit Types, Vessel Name, Vessel Identification Number, and in the case of a “for hire” vessel the Passenger Capacity, or individual, corporate and lease holders of permits. 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.

1 Landing of allowable aquaculture species is prohibited at non-U.S. ports, unless first landed at a U.S. port.

2 Species cultured at an aquaculture facility can only be landed ashore between 6 a.m. and 6 p.m., local time.

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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	jess.beck
File Modified	0000-00-00
File Created	2021-01-24