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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 pm. ET)
sero.nmfs.noaa.gov/permits
0MB Control Number 0648-0205, Expiration Date 04/30/2017
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FEDERAL PERMIT APPLICATION FOR
VESSELS FISHING IN THE EXCLUSIVE
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ECONOMIC ZONE (EEZ)
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 vessels state registration does not list all owiers, also provide a copy
of the vessel’s title, or other documentation from the appropriate state agency, that identifies all vessel owners.
SECTION 1
Official Number From USCG Certificate Of
Documentation (If the vessel is documented)
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VESSEL IN FORMATION
Year Built
Length (ft)
Total Horsepower
State Registration Number (as applicable)
Crew Size—Including the Captain,
but not including passengers.
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 State
Hailing Port County Or Parish
Product Storage
(check all that
apply)
Fuel Data
FIBERGLASS
DIESEL
STEEL
GASOLINE
WOOD
OTHER
(DESCRIBE)
D
ON ICE IN
HOLD, FISH
BOX, ICE
CHEST,
COOLER,
ETC
CEMENT
FREEZER
OTHER
USCG DOCUMENTED VESSELS ONLY
(DESCRI BE)
Net Tons
Gross Tons
Passenger Capacity Data For Charter
Vessels/Headboats Only
This vessel is
used MOSTLY for
(select only one)
UNISPECTED VESSEL “6-PACK”
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Commercial
Fishing
USCG INSPECTED VESSEL: Specify
Passenger Capacity as listed on the USCG
Charter
H Certificate of Inspection, not including Capt.
and Crew.
Head boat
Fuel Capacity
Total Gallons
LIVE WELL
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H
For Shark and Swordfish Directed and
Incidental Permit Applicants Only: Does your
vessel fish with, or carry onboard, either
longline 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 04/08/2015
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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:
2: $35
1 Permit: $25
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 FL SPL information below.
SPANISH MACKEREL (SM)
SMOOTHHOUND SHARK (SHS)
ROCK SHRIMP
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CAROLINAS ZONE
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/H EADBOAT 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
TRANSFER
LIMITED ACCESS CHARTER/HEADBOAT PERMITS
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)
3
RENEW
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.
show the vessel owner as a person or persons?
Does your USCG Documentation or State Registration
YES Use this page for the
vessel 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
Is a person or persons leasing this vessel from the vessel
owner?
lessee
YES Use Section 4b for the
NO The lessee iso business
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vessel is leased
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Put lessee info in Section 5b
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 list their information here.
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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
City
Apt #
State
Phone Number
County/Parish
LH
Zip Code
H
Country
H___
Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)
City
Apt #
State
County/Parish
Zip Code
Country
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
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
City
Apt #
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 (Pa Box not acceptable)
City
Apt #
H
H
H
4
H___
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
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I
Does your USCG Documentation or State Registration
show more than one business as the vessel owner?
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YES Use Section Sb for the
lessee
a business or businesses leasing this vessel from the
vessel owner?
SECTION 5a
YES Use Sections 5a and
or the vessel owners
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NO Fill out previous page
for vessel owners
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NO Fill out Section Sb if
vessel is leased
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NO The lessee iso person
Put lessee info in Section 4b
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 list their information in Sections 5a and
5b.
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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)
Date Business Formed (MM/DD/YYYY)
Mailing Address
City
Apt #
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)
E
City
Apt #
HL
SECTION 5b
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H_H
1
H
Vessel Lessee OR Joint Vessel Owner on the USCG Certificate of Documentation or State Registration
1) If the USCG Documentation or State Registration shows more than one business as sole vessel owner list their information here.
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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)
Date Business Formed (MM/DD/YYYY)
Mailing Address
City
Apt #
r
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)
City
Apt #
H
H
H
5
H______
H______
SECTION 6 OFFICER/SHAREHOLDER INFORMATION FOR BUSINESS(ES) THAT OWN OR LEASE THE VESSEL
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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
Owner or lessee of the vessel:
Lessee
Federal Tax ID Number
Business name
Position Held
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Check ALL That Apply
President/CEO
Vice President
Secretary
Treasurer
Director/ Manager
Shareholder
Percent of Corporation Held
Is this person a United States citizen or permanent resident alien?
Mr/Mrs/Ms
First Name
Middle Name
Date of Birth (MM/DD/YYYY)
Area Code
Last Name
Tax Identification Number (SSN)
Apt if
Mailing Address
City
Other
YES
NO
Suffix ir, Sr, etc.
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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 if
City
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
Is this person 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
Other
YES
NO
Suffix ir, Sr, etc.
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Phone Number
H________
Mailing Address
Apt if
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 if
City
Minor Shareholder Information
MINOR SHAREHOLDERS
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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 shareholder(s)
6
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 Fish
Designated Operator (Income Qualifier other than the Permit Holder) for Commercial Spiny Lobster
A Historical Captain MUST sign Section 9 as 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
HH
Suffix ir, Sr, etc.
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Phone Number
County/Parish
1111
J Check box if the street address is the same as the mailing address.
Street Address (P0 Box not acceptable)
Apt # City
State
Zip Code
Country
H_H__
County/Parish
Zip Code
Country
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 Floy Tag, Inc.
I need tags for:
Sea Bass Pots
Golden Crap Traps
1
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 iooi, 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
requires the separation of the tail and carapace to maintain quality product.
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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 Section 6.
Applicant Signature
Position in Business
]Date
Print Name
Designated Operator
Signature
1
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
below).
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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
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.
The following information applies to my income qualification for the Spiny Lobster fishery:
I.
hereby declare under penalty of perjury that the foregoing
information is true and correct (28 usc 1746; 18 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
Printed Name
(date signed).
Signature
Business Name (if Applicable)
Type of business (if Applicable)
Position In Business (if Applicable)
Public reporting burden for this 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/SLR26, 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. Name and address information will be released via a NOAA website. All other data submitted will be handled as confidential material in uccordance
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 0MB control Number.
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File Type | application/pdf |
File Modified | 0000-00-00 |
File Created | 2015-08-05 |