Federal Fisheries Application for Vessels Fishing for Wr

OMB Control No. 0648-0205; Expiration date: 04/30/2017

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 a.m. - 4:30 p.m. ET)
727-824-5326 (8:00 a.m. - 4:30 p.m. ET)
permits.sero.nmfs.noaa.gov

FEDERAL PERMIT APPLICATION FOR
VESSELS FISHING FOR WRECKFISH
OFF THE SOUTH ATLANTIC STATES
FOR OFFICE USE ONLY
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 vessel's title, or other documentation from the appropriate state agency, that identifies all vessel owners.

SECTION 1 - VESSEL INFORMATION
Official Number From USCG Certificate Of
Documentation (If the vessel is documented)

Year Built

Total Horsepower

Length (ft)

State Registration Number (as applicable)
Crew Size—Including the Captain
HOLD or FISH BOX CAPACITY: How many
pounds of product can you bring to the dock
when full?

Vessel Name

Hull Identification Number (HIN)
Hull Material
Hailing Port City

Hailing Port County Or Parish

Hailing Port State

Fuel Data

FIBERGLASS

DIESEL

STEEL

GASOLINE

WOOD

OTHER
(DESCRIBE)

CEMENT
OTHER
(DESCRIBE)

USCG DOCUMENTED VESSELS ONLY
Gross Tons
Net Tons

Product Storage
(check all that
apply)
ON ICE IN
HOLD FISH
BOX, ICE
CHEST,
COOLER,
FREEZER

Fuel Capacity Total Gallons

LIVE WELL

International Maritime Organization (IMO) Number
As applicable (see instructions)

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W2015.2x; Form Revision 12/18/2015

SECTION 2 - WRECKFISH SHAREHOLDER INFORMATION - Shareholder’s Certificate Number
Complete Section 2a on this page for the sole or primary Wreckfish Shareholder. If the Wreckfish Shareholder is a business, enter the Federal ID
number under Tax ID Number and date the business was filed under Date of Birth. If the Wreckfish Shareholder is an individual, enter the Social
Security Number and date of birth. Complete section 2b for a joint shareholder. Photocopy this page as needed to provide information on all
shareholders.

SECTION 2a—Primary Shareholder Information
Sole Shareholder

Co-Shareholder

Percent of Ownership

MAILING RECIPIENT - All mail about this permit will go to the person listed in Section 2a
Is this person a United States Citizen or permanent resident alien?
What is your Sex?
What is your
race? (Check
all that apply)

Male

YES

NO

Are you of Hispanic, Latino, or Spanish origin?

Female

American Indian or Alaska
Native

White
Black or African American

Yes

No

Native Hawaiian or Other Pacific Islander
Other _______________

Asian American

Middle Name

First Name

Last Name

Check here if you would you like to receive
digital updates (texts & emails). Provide
your digital contact information below.

Suffix - Jr, Sr, etc.

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

Date of Birth (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Email

SECTION 2b Joint Shareholder Information
Sole Shareholder

Co-Shareholder

Percent of Ownership

MAILING RECIPIENT - All mail about this permit will go to the person listed in Section 2b
Is this person a United States Citizen or permanent resident alien?
What is your Sex?
What is your
race? (Check
all that apply)

Male

YES

White

American Indian or Alaska
Native

Black or African American

Asian American

Tax ID Number (SSN)

Mailing Address

NO

Are you of Hispanic, Latino, or Spanish origin?

Female

Last Name

Check here if you would you like to receive
digital updates (texts & emails). Provide
your digital contact information below.

Date of Birth (MM/DD/YYYY)

Apt #

City

No

Native Hawaiian or Other Pacific Islander
Other _______________

Middle Name

First Name

Yes

Area Code

Suffix - Jr, Sr, etc.

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Email

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SECTION 3 - INDIVIDUAL VESSEL OWNER(S) INFORMATION
Section 3a: Primary or Sole Owner: Complete this section if there is one individual shown on the USCG documentation, State Registration or
title as the registered joint owner of the vessel. Co-Ownership percentage must add up to 100% Select only ONE mailing recipient.
Co-Owner
Sole Owner
Percent of Ownership
MAILING RECIPIENT - All mail about this permit will go to the person listed in Section 4a
YES

Is this person a United States Citizen or permanent resident alien?
What is your Sex?
What is your
race? (Check
all that apply)

Male

NO

Check here if you would you like to receive
digital updates (texts & emails). Provide
your digital contact information below.

Are you of Hispanic, Latino, or Spanish origin?

Female

Yes

No

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Middle Name

First Name

Last Name

Suffix - Jr, Sr, etc.

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

Date of Birth (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Digital contact information
(number and provider):

Email

Section 3b: Joint Owner. Complete this section if there is more than one person shown on the USCG documentation, State Registration or title as
the registered owner of the vessel. Co-Ownership percentage must add up to 100% Copy this page as needed to include ALL owners of the vessel.
Co-Owner

Percent of Ownership

MAILING RECIPIENT - All mail about this permit will go to the person listed in Section 4b
Is this person a United States Citizen or permanent resident alien?
What is your Sex?
What is your
race? (Check
all that apply)

Male

YES

NO

Check here if you would you like to receive
digital updates (texts & emails). Provide
your digital contact information below.

Are you of Hispanic, Latino, or Spanish origin?

Female

Yes

No

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

Middle Name

First Name

Suffix - Jr, Sr, etc.

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

Mailing Address

Date of Birth (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 Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Email

Apt #

City

Digital contact information
(number and provider):

3

SECTION 3 - INDIVIDUAL VESSEL OWNER(S) INFORMATION - Continued
Section 4c: Business Type: Mark the business that BEST DESCRIBES the individual or individuals listed in section 4:
Partnership

Sole Proprietorship

SECTION 4 –BUSINESS VESSEL OWNER(S) INFORMATION
Section 4a: Primary or Sole Owner: Complete this section if there is one business shown on the USCG Documentation, State Registration
or Title as the registered owner of the vessel. Co-Ownership percentage must add up to 100% Select only ONE mailing recipient.
Sole Owner
Type of
business:

Check here if you would you like to receive
digital updates (texts & emails). Provide your
digital contact information below.

Percent of Ownership

Co-Owner
S Corporation

Cooperative

C Corporation

Limited Liability Co.

Other

MAILING RECIPIENT - All mail about this permit will go to the business listed in Section 5a
Registered Name of Business
Email Address
Tax ID Number (FEIN)

Date Business Formed (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Digital contact information
(number and provider):

Email

Section 4b: Joint Owner: Complete this section if there is another business shown on the USCG Documentation, State Registration or Title
as the registered joint owner of the vessel. Co-Ownership percentage must add up to 100% Copy this page as needed to include ALL
business owners of the vessel.
Co-Owner
Type of
business:

Check here if you would you like to receive
digital updates (texts & emails). Provide your
digital contact information below.

Percent of Ownership
S Corporation

Cooperative

C Corporation

Limited Liability Co.

Other

MAILING RECIPIENT - All mail about this permit will go to the business listed in Section 5a
Registered Name of Business
Email Address
Tax ID 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 Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Email

Apt #

City

Digital contact information
(number and provider):

Minor Shareholder Information: In this section, mark the minor shareholder box only if one or more shareholders individually hold shares that
are less than 1% of the total business shares. Major Shareholders and Company officers must be listed in section 6
TOTAL PERCENTAGE of the business shares held

MINOR SHAREHOLDERS - Check here

by minor shareholder(s)

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SECTION 5 - 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. The shareholder percentages for section 6 must total 100%.
Copy this page as necessary to provide information on all persons that are officers/shareholders of the business(es) shown in Section 5.
Business name

Federal Tax ID Number

5a: Additional Ownership:
Business — provide Business Name in last name box and FEIN in SSN box. Provide the

Check here if you would you like to receive
digital updates (texts & emails). Provide your
digital contact information below.

date the Business was formed with the Secretary of State in the Date of Birth box

Position Held - Check ALL That Apply
President/CEO

Vice President

Secretary

What is your
race? (Check
all that apply)

Director/ Manager

Other/Shareholder

Is this person a United States Citizen or permanent resident alien?

Percent of Business Owned
What is your Sex?

Treasurer

Male

Are you of Hispanic, Latino, or Spanish origin?

Female

Yes

YES
No

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Middle Name

First Name

Last Name

Tax ID Number (SSN), or if a Business (FEIN)

Mailing Address

Date of Birth (MM/DD/YYYY)

Apt #

City

Area Code

NO

Suffix - Jr, Sr, etc.

Phone Number

State

County/Parish

Zip Code

State

County/Parish Zip Code

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Digital contact information
(number and provider):

Email

Check here if you would you like to receive
digital updates (texts & emails). Provide
your digital contact information below.

5b:
Position Held - Check ALL That Apply
President/CEO

Vice President

Secretary

What is your
race? (Check
all that apply)

Director/ Manager

Other/Shareholder

Is this person a United States Citizen or permanent resident alien?

Percent of Business Owned
What is your Sex?

Treasurer

Male

Are you of Hispanic, Latino, or Spanish origin?

Female

Yes

No

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

Tax ID Number (SSN), or if a Business (FEIN)

Mailing Address

Middle Name

First Name

Date of Birth (MM/DD/YYYY)

Apt #

City

Area Code

Suffix - Jr, Sr, etc.

Phone Number

State

County/Parish

Zip Code

State

County/Parish Zip Code

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Email

YES

Apt #

City

Digital contact information
(number and provider):

5

NO

SECTION 7 - SMALL BUSINESS CERTIFICATION
Please use the following tool to determine if you are classified as a small business and check the appropriate box(es) below.
When proposing regulations, the National Marine Fisheries Service (NMFS) is required to analyze the economic effects of such regulations on
small entities (e.g., businesses). As part of the required analyses, NMFS must determine if permit owners are big or small entities according to
standards established by the Small Business Administration (SBA) or NMFS. Only one standard applies to each entity. For businesses, the standard
is based on their primary North American Industry Classification System (NAICS) code, which indicates the industry the business is primarily en‐
gaged in. The SBA also has established “principles of affiliation” to determine whether a business concern is “independently owned and operat‐
ed.” In general, businesses are affiliates of each other when one business controls or has the power to control the other business or a third party
controls or has the power to control both.
We are a small organization that is a nonprofit enterprise that is independently owned and operated and is not dominant in its field.
We are a business primarily involved in harvesting seafood (NAICS 114111, 114112, or 114119) that is independently owned and operated, not
dominant in its field of operation (including its affiliates), and has total annual gross receipts less than $11 million for all its affiliated operations
worldwide.
We are a business primarily involved in providing for‐hire (charter, party/headboat) fishing services (NAICS 487210) that has total annual
gross receipts less than $7.5 million for all its affiliated operations worldwide.
We are a business primarily involved in buying and selling seafood (NAICS 424460) that is independently owned and operated, not dominant in
its field of operation, and employs 100 or fewer persons on a full time, part time, temporary, or other basis, at all its affiliated operations world‐
wide.
Our business primarily involved in processing seafood (NAICS 311710). it is independently owned and operated, not dominant in its field of
Our business is primarily involved in some other industry. Please refer to SBA’s list of size standards by NAICS code
(see https://www.sba.gov/sites/default/files/files/Size_Standards_Table.xlsx) to determine if your business is small.

YES, we marked one of the above boxes and we are a small business or organization.
NO, we did not mark one of the above boxes and are a big business or organization.
If you have any questions about these standards or the definition of affiliation, please contact Mike Travis, SERO Economist, at
[email protected] or call 727-209-5982.

SECTION 7 - SIGNATURE - REQUIRED
If the Wreckfish Shareholder is not the vessel owner, the undersigned certifies and documents that the vessel owner or operator is an employee,
contractor or agent of the shareholder.
Shareholder’s Signature

Date
Position in Business

Print Name

Public reporting burden for this collection of information is estimated to average 21 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 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.

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