Form 3-200-85 Application to Establish a Master File for the Export of

	Department of the Interior U.S. Fish and Wildlife Service Federal Fish and Wildlife Permit Application Form		OMB Control No. 1018-0093 Expires ##/##/####
Return to: U.S. Fish and Wildlife Service Division of Management Authority (DMA) Branch of Permits, MS: IA 5275 Leesburg Pike Falls Church, VA 22041-3803 1-800-358-2104 or 703-358-2104		Type of Activity: ESTABLISHMENT A MASTER FILE FOR THE EXPORT OF LIVE ANIMAL BRED IN CAPTIVE (CITES) (Multiple Commercial Shipments) ___ New Application ___ Amendment or Re-issuance of Master File # ___________

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.

See attached instruction pages for information on how to make your application complete and help avoid unnecessary delays.

A.	Complete if applying as an individual
1.a. Last name			1.b. First name	1.c. Middle name or initial	1.d. Suffix
2. Date of birth (mm/dd/yyyy)		3. Telephone number	3.a. Alternate telephone number	4. E-mail address

B.	Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution				1.b. Doing business as (dba) 
2. Tax identification no.			3. Description of business, agency, Tribe, or institution
4.a. Principal officer Last name			4.b. Principal officer First name				4.c. Principal officer Middle name/ initial		4.d. Suffix
5. Principal officer title 						6. Primary contact name
7.a. Business telephone number		7.b. Alternate telephone number			7.c. Business fax number			7.d. Business e-mail address

C.		Applicant address All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes) (If Broker or Taxidermist is applying on behalf of a foreign national, provide Broker or Taxidermist’s name and address in this block; U.S. hunters must provide their U.S. address)
1.b. City	1.c. State			1.d. Zip code/Postal code:		1.e. County/Province		1.f. Country
2.a. Mailing Address (include if different than physical address; include name of contact person if applicable)
2.b. City	2.c. State		2.d. Zip code/Postal code:		2.e. County/Province		2.f. Country

D.	All applicants MUST complete
1.			Attach check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the amount of $100, nonrefundable processing fee. Federal, Tribal, State, and local government agencies, and those acting on behalf of such agencies, are exempt from the processing fee – attach documentation of fee exempt status as outlined in instructions. (50 CFR 13.11(d))
2.		Certification: I hereby certify that I have read and am familiar with the regulations contained in Title 50, Part 13 of the Code of Federal Regulations and the other applicable parts in subchapter B of Chapter I of Title 50, and I certify that the information submitted in this application for a permit is complete and accurate to the best of my knowledge and belief. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001. ________________________________________________________________________________________________________________________ Signature of applicant/Principal Officer for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)

Please continue to next page

E. ESTABLISHMENT OF A MASTER FILE FOR THE EXPORT OF LIVE ANIMALS BRED IN CAPTIVITY IN THE UNITED STATES (CITES)

This application allows you set up a Master File for exports of live animals bred in captivity under CITES. The Master File is valid for three years and is renewable. Once the Master File is approved you must obtain single-use permits, valid for 6 months, for each export (50 CFR 13.11).

Note 1: Species that are listed on pages 5 and 6 of this application are currently eligible for inclusion in a master file. This list contains species where it has been determined that specimens were born or hatched from parents mated in captivity in the United States qualify as Bred-in-Captivity in accordance with CITES Resolution Conf. 10.16 (Rev.) and are therefore eligible for issuance of certificates under the provisions of CITES Article VII, paragraph 5. If a species you are interested in including on a master file is not listed, you may either submit application form 3-200-24 or complete questions 6 through 10 of this application to request that specimens produced at your facility be considered Bred-in-Captivity. If it is determined that your specimens do not meet the criteria under Resolution Conf. 10.16 (Rev.), you may still be eligible to obtain individual export permits for the specimens.

Note 2: We may not be able to issue CITES documents for the commercial export of Appendix-I specimens, unless the specimens were produced at a commercial breeding operation that is registered with CITES Secretariat. For more information on registering commercial breeding operation for Appendix-I wildlife, contact the Division of Management Authority at 800-358-2104 or [email protected].

Electronic submission of inventories, photographs, and receipts: Some applications contain extensive inventories and /or a large number of photographs or receipts. You may provide electronic versions of the documents. Such a submission will assist in expediting the processing of your application since it may reduce data entry by the U.S. Fish and Wildlife Service. If you wish to provide information electronically, please either include a disk containing your information or, once you have received an application number via the e-mailed acknowledgement letter, e-mail your information to [email protected]. Be sure to include the application number provided in the acknowledgement e-mail that will be sent to you when we receive your application.

_____ I will be submitting documents electronically.

I would like to:

____ ESTABLISH A NEW MASTER FILE (Processing Fee = $200)

____RENEW AND/OR AMEND AN EXISTING MASTER FILE, # _________ (Processing Fee = $100)

How many single-use permits do you anticipate using in the next 6 months? ______________

Provide $5 for each 6-month permit. Additional permits may be requested by submitting form 3-200-74 (http://www.fws.gov/international/permits/by-form-number/index.html).

Please respond to each of the following questions and provide all information requested. Mark items that are not applicable with “N/A”. If needed, use separate sheets of paper. Please indicate the question/item number you are addressing on all attachments or separate sheets you submit. If you are applying for multiple species, be sure to indicate which species you are addressing in each response.

1. Name and address where you wish the permit to be mailed, if different from page 1. If you would like expedited shipping, please enclose a self-addressed, pre-paid, computer-generated, courier service airway bill. If unspecified, all documents will be mailed via regular mail through the U.S. Postal Service.

2. Whom should we contact if we have questions about the application (name, phone number, and e-mail)?

3. Have you or any of the owners of the business (if applying as a business, corporation, or institution), been assessed a civil penalty or convicted of any criminal provision of any statute or regulation relating to the activity for which the application is filed; been convicted, or entered a plea of guilty or nolo contendere, for a felony violation of the Lacey Act, the Migratory Bird Treaty Act, or the Bald and Golden Eagle Protection Act; forfeited collateral; OR are currently under charges for any violation of the laws mentioned above?

No Yes

If you answered “Yes” to Question 3, provide: a) the individual’s name; b) date of charge; c) charge(s); d) location of incident; e) court, and f) action taken for each violation. Please be aware that a “Yes” response does not automatically disqualify you from getting a permit.

4. For EACH wildlife species to be shipped, provide the following information:

   1. Scientific name (genus, species, and, if applicable, subspecies);

   2. Common name;

   3. Typical description of specimens to be exported (e.g., hatchlings, sub-adults; typical size);

   4. Estimated annual production of specimens;

   5. Estimated annual export of specimens; and

   6. Normal mortality rates at your facility.

5. Where are the specimens currently located? (e.g., physical address of facility including county).

1. Name:

2. Street Address:

3. City/Province:

4. State:

5. Country, Postal Code:

6. As the Breeder, sign (in ink) the following statement:

1. I hereby certify that the species listed above to be exported were bred and born/hatched from parental stock at my facility listed below. (Additional information on the parental stock may be requested upon receipt of your application).

2. Name and address of your facility where the animals were bred and born/hatched:

3. Name of facility/operation:

4. Street Address:

5. City, State, Zip Code:

6. Current location of parental stock:

7. Street Address:

8. City, State, Zip Code:

7. Signature _________________________________________________ Date __________________

8. If you are NOT the breeder of the specimen(s), provide copies of documentation showing that you acquired the

   1. Animal(s) from the breeder or documentation demonstrating the history of transactions (chain of ownership of each animal) and a signed statement from the breeder or breeder's record that includes:

1. that the animal was bred and born/hatched at his/her facility;

2. birth/hatch date, and, if applicable, band/tag number, or other identifiers;

3. sex of each specimen he/she bred;

4. location (Name, Street address, City, State) of Parental Stock;

5. complete name and address of the breeder's facility.

9. Provide labeled photographs depicting the facilities for the specimens described in your application.

10. If the species you intend to export appears on the attached list, skip questions 11 – 16.

11. For species that are NOT included on the attached list: As stated above, in order to establish a master file, the species being proposed for export must be on the attached list (page 5 and 6). For species that are NOT included on the attached list, you can request that the species be approved for your facility by completing the questions 6 - 10:

12. Provide information about the breeding facility, including:

    1. Property size;

    2. Size and type of facility buildings (such as, food prep room and incubation facilities);

    3. Size and type of cage or enclosure used to house juveniles, adults, hatchlings, as appropriate;

    4. Are the cages or enclosures indoors or outdoors?

    5. How many cages and enclosures does the facility provide?;

    6. How is the location secured (i.e., fence, guard dog, electric wire, etc.) from both theft and natural disaster?

    7. How are animals uniquely identified (pit tags, leg bands, notching, photos)?

13. Provide documentation that demonstrates that the founder stock was legally obtained in accordance to CITES and with foreign, State and local laws (all original stock used to produce the offspring even if now dead or no longer able to breed). Examples of documentation include CITES Permits, State Collecting Permits, receipts, or letters of affidavit from original breeder on how they obtained these animal, and receipts showing the chain of custody.

14. Provide any available documentation that the breeding stock was acquired in a manner that was not detrimental to the species. Examples of documentation include information on status of the species in the wild; the availability of the species in the domestic and international trade; and the ease/difficulty of breeding the species in captivity.

14. Provide evidence that applicant is able to consistently produced offspring of second or subsequent generations (F2 or greater) in a controlled environment, or that you are managing in a way that has been demonstrated to be capable of reliably producing second generation offspring and has produced first‐generation offspring, including:

    1. List of breeding stock that includes identification (name or number)of specimens, born/hatched date, location born/hatched, and sex;

    2. Pedigrees of the breeding stock;

    3. How long have you bred the species?

    4. How many generations has the applicant produced (F1, F2, F3 etc….)?

    5. How many breeding females and breeding males?

    6. Has the applicant held back offspring produced to be parental stock? If so how many male and females?

    7. What is the estimated annual production?

    8. Average mortality rate/yr (juveniles and adults)?

    9. What is the anticipated annual export amount?

14. What are your future plans for supplementing their breeding stock especially as it pertains to introducing new wild stock?

    1. Will specimens be added either to prevent or alleviate deleterious inbreeding?

    2. Is there captive stock available in the United States or elsewhere such that supplementation from the wild is not necessary?

All Applicants Complete the following:

14. The transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals or, in the case of air transport, with the International Air Transport Association (IATA) live animal regulations (contact airline for information). As such, describe:

    1. The type, size, and construction of any shipping container; and

    2. The arrangements for watering or otherwise caring for the wildlife during transport.

14. Attach copies of any applicable State permits or licenses, such as commercial breeding or sales licenses (contact your State for information).

14. If the species is part of an approved WBCA Cooperative Breeding Program, identify the breeding operation and provide an explanation of how the specimen is surplus to the operation.

All international shipment(s) must be through a designated port. A list of designated ports (where an inspector is posted) is available from http://www.fws.gov/le/designated-ports.html. If you wish to use a port not listed, please contact the Office of Law Enforcement for a Designated Port Exemption Permit (form 3-200-2).

FOR THE PURPOSE OF EXPORT FROM THE UNITED STATES
SPECIES THAT QUALIFY AS CAPTIVE-BRED
IN ACCORDANCE WITH CONF. 10.16

MAMMALS

Order Primates

Callithrix jacchus - Common marmoset [App. II]

Cercocebus agilis – Agile mangabey [App. II]

Lophocebus spp. – Mangabeys [App. II]

Erythrocebus patas - Patas monkey [App. II]

Macaca fascicularis - Crab-eating macaque [App. II]

Macaca mulatta - Rhesus monkey [App. II]

Order Carnivora

Canis lupus (Alaskan population) - Gray wolf [App. II]

Caracal (=Felis) caracal - Caracal [excluding Asian population]

Leptailurus (=Felis) serval - Serval [App. II]

Panthera leo - Lion [excluding Asian population]

Order Artiodactyla

Antilope cervicarpa - Blackbuck [App. III]

Hexaprotodon liberiensis- Pygmy hippopotamus [App. II]

Hippopotamus amphibius - Hippopotamus [App. II]

Lama guanicoe - Guanaco [App. II]

BIRDS

Order Anseriformes

Cygnus melanocoryphus - Black-necked swan [App. II]

Order Falconiformes

Buteo buteo - European buzzard [App. II]

Order Galliformes

Argusianus argus - Great argus pheasant [App. II]

Gallus sonneratii - Sonnerat'sjunglefowl, Gray junglefowl [App. II)

Polyplectron bicalcaratum - Gray peacock pheasant [App. II]

Polyplectron germaini - Germain's peacock pheasant [App. II]

Polyplectron malacense - Malaysian peacock pheasant [App. II]

Order Psittacifornies

Aratinga jandaya - Jendaya parakeet [App. II]

Barnardius zonarius barnardi - Malice ringneck parrot [App. II]

Bolborhynchus lineola - Lineolated parakeet [App. II]

Cyanoramphus auriceps - Yellow-fronted parakeet [App. II] (excluding C. a. forbesi)

Forpus coelestis - Pacific parrolet [App. II]

Neophema chrysostoma - Blue-winged parrot [App. II]

Neophema elegans - Elegant parrot [App. II]

Platycercus adscitus - Pale-headed rosella [App. II]

Platycercus elegans - Crimson rosella [App. II]

Platycercus eximius - Eastern rosella [App. II]

Platycercus icterotis - Western (Stanley) rosella [App. II]

Platycercus venustus - Northern rosella [App. II]

Polytelis alexandrae - Princess parrot [App. II]

Polytelis anthopeplus - Regent parrot [App. II]

Polytelis swainsonii - Superb parrot [App. II]

Psephotus haematonotus - Red-rumped parakeet [App. II]

Psephotus varius - Mulga parakeet [App. II]

Psittacula eupatria - Alexandrine parakeet [App. II]

Purpureicephalus spurius - Red-capped parrot [App. II]

Trichoglossus chlorolepidotus - Scaly-breasted lorikeet [App. II]

Order Passeriformes

Poephila cincta cincta - Parson finch [App. II]

REPTILES

Order Squamata

Antaresia childreni - Children's python [App. II]

Antaresia maculosa - Spotted python [App. II]

Antaresia perthensis - Pygmy python [App. II]

Boa constrictor - Boa constrictor [App. II] (includes B. c. contrictor, B. c. imperator, B. c. melanogaster, B. c. mexicana, and B. c. ortonii)

Eryx johnii - Blunt-tailed sand boa [App. II]

Eunectes murinus - Green anaconda [App. II]

Morelia spilota variegata - Carpet python [App. II]

Python curtus - Sumatran short-tailed python [App. II]

Python reticulatus - Reticulated python [App. II]

Python molurus bivittatus - Burmese python [App. II]

Python regius - Ball or royal python [App. II]

Python sebae - African rock python [App. II]

Python natalensis - Southern African rock python [App. II]

AMPHIBIANS

Order Caudata

Ambystoma mexicanum - Axolotl [App. II]

APPLICATION FORM INSTRUCTIONS

The following instructions pertain to an U.S. Fish and Wildlife Service (FWS) permit applications. The General Permit Procedures in 50 CFR 13 address the permitting process. For simplicity, all licenses, permits, registrations, and certificates are referred to as a permit.

GENERAL INSTRUCTIONS:

• Complete all relevant questions in Sections A or B, C, D, and E.

• An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are filling in the appropriate application form for the proposed activity.

• Print clearly or type in the information. Illegible applications may cause delays.

• Sign the application. Faxes or copies of the original signature will not be accepted.

• Mail the original application to the address at the top of page one of the application or, if applicable, on the attached address list.

• Keep a copy of your completed application.

• Please plan ahead. Allow at least 60 days for your application to be processed, however, some applications may take longer than 90 days to process (50 CFR 13.11).

• Applications are processed in the order they are received.

SECTION A OR SECTION B:

Section A. Complete if applying as an individual [do not complete this section if applying for Import/Export License (3-200-3)]:

• Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal information that identifies the applicant. Fax and e-mail, while helpful in processing, are not required.

• If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing power of attorney must be included with the application.

• Affiliation/ Doing business as (dba): business, agency, Tribe, organizational, or institutional affiliation directly related to the activity requested in the application (e.g., a taxidermist is an individual whose business can directly relate to the requested activity). The Division of Management Authority (DMA) and the Office of Law Enforcement (OLE) do not accept doing business as affiliations for individuals (complete Section B)..

Section B. Complete if applying as a business, corporation, public agency, Tribe, or institution:

• Enter the complete name of the business, agency, or institution that will be the permittee if a permit is issued. Give a brief description of the type of business the applicant is engaged in. Provide contact phone number(s) of the business. If you are applying on behalf of a client, a document evidencing power of attorney must be included with the application.

• Principal Officer is the person in charge of the listed business, corporation, public agency, Tribe, or institution. The principal officer is the person responsible for the application and any permitted activities. Often the principal officer is a Director or President. Primary Contact is the person at the business, corporation, public agency, or institution who will be available to answer questions about the application or permitted activities. Often this is the preparer of the application.

ALL APPLICANTS COMPLETE SECTION C:

• For all applications submitted to the Division of Management Authority (DMA), a physical U.S. address is required.

• Mailing address is the address to which communications from USFWS should be mailed if different from applicant’s physical address.

ALL APPLICANTS COMPLETE SECTION D:

Section D.1 Application processing fee:

• An application processing fee is required at the time of application, unless exempted under 50 CFR13. The application processing fee is assessed to partially cover the cost of processing a request. The fee does not guarantee the issuance of a permit, nor will fees be refunded for applications for which processing has begun.

• Documentation of fee exempt status is not required for applications submitted by Federal, Tribal, State, or local government agencies; but must be supplied by those applicants acting on behalf of such agencies. Such applications must include a letter on agency letterhead and signed by the head of the unit of government for which the applicant is acting on behalf, confirming that the applicant will be carrying out the permitted activity for the agency.

Section D.2 Federal Fish and Wildlife permits:

• List the number(s) of your most recent issued USFWS permit. If applying for re-issuance of a CITES permit, the original permit must be returned with this application.

Section D.3 CERTIFICATION:

• The individual identified in Section A, the principal officer named in Section B, or person with a valid power of attorney (documentation must be included in the application) must sign and date the application. This signature legally binds the applicant to the statement of certification. You are certifying that you have read and understand the regulations that apply to the permit. You are also certifying that all information included in the application is true to the best of your knowledge. Be sure to read the statement and re-read the application and your answers before signing.

ALL APPLICANTS COMPLETE SECTION E

Please continue to next page. DO NOT RETURN THIS PAGE WITH THE APPLICATION

APPLICATION FOR A FEDERAL FISH AND WILDLIFE PERMIT

Paperwork Reduction Act, Privacy Act, and Freedom of Information Act – Notices

In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) and the Privacy Act of 1974 (5 U.S.C. 552a), please be advised:

1. The gathering of information on fish and wildlife is authorized by:

(Authorizing statutes can be found at: http://www.gpoaccess.gov/cfr/index.html and http://www.fws.gov/permits/ltr/ltr.html

a. Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22;

b. Endangered Species Act of 1973 (16 U.S.C. 1531-1544), 50 CFR 17;

c. Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21;

d. Marine Mammal Protection Act of 1972 (16 U.S.C. 1361, et. seq.), 50 CFR 18;

e. Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15;

f. Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;

g. Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), http://www.cites.org/ , 50 CFR 23;

h. General Provisions, 50 CFR 10;

i. General Permit Procedures, 50 CFR 13; and

j. Wildlife Provisions (Import/export/transport), 50 CFR 14.

2. Information requested in this form is purely voluntary. However, submission of requested information is required in order to process applications for permits authorized under the above laws. Failure to provide all requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. We may not conduct or sponsor and you are not required to respond to collection of information unless it displays a currently valid OMB control number.

3. Certain applications for permits authorized under the Endangered Species Act of 1973 (16 U.S.C. 1539) and the Marine Mammal Protection Act of 1972 (16 U.S.C. 1374) will be published in the Federal Register as required by the two laws.

4. Disclosures outside the Department of the Interior may be made without the consent of an individual under the routine uses listed below, if the disclosure is compatible with the purposes for which the record was collected. (Ref. 68 FR 52611, September 4, 2003)

a. Routine disclosure to subject matter experts, and Federal, Tribal, State, local, and foreign agencies, for the purpose of obtaining advice relevant to making a decision on an application for a permit or when necessary to accomplish a FWS function related to this system of records.

b. Routine disclosure to the public as a result of publishing Federal Register notices announcing the receipt of permit applications for public comment or notice of the decision on a permit application.

c. Routine disclosure to Federal, Tribal, State, local, or foreign wildlife and plant agencies for the exchange of information on permits granted or denied to assure compliance with all applicable permitting requirements.

d. Routine disclosure to Captive‑bred Wildlife registrants under the Endangered Species Act for the exchange of authorized species, and to share information on the captive breeding of these species.

e. Routine disclosure to Federal, Tribal, State, and local authorities who need to know who is permitted to receive and rehabilitate sick, orphaned, and injured birds under the Migratory Bird Treaty Act and the Bald and Golden Eagle Protection Act; federally permitted rehabilitators; individuals seeking a permitted rehabilitator with whom to place a bird in need of care; and licensed veterinarians who receive, treat, or diagnose sick, orphaned, and injured birds.

f. Routine disclosure to the Department of Justice, or a court, adjudicative, or other administrative body or to a party in litigation before a court or adjudicative or administrative body, under certain circumstances.

g. Routine disclosure to the appropriate Federal, Tribal, State, local, or foreign governmental agency responsible for investigating, prosecuting, enforcing, or implementing statutes, rules, or licenses, when we become aware of a violation or potential violation of such statutes, rules, or licenses, or when we need to monitor activities associated with a permit or regulated use.

h. Routine disclosure to a congressional office in response to an inquiry to the office by the individual to whom the record pertains.

i. Routine disclosure to the Government Accountability Office or Congress when the information is required for the evaluation of the permit programs.

j. Routine disclosure to provide addresses obtained from the Internal Revenue Service to debt collection agencies for purposes of locating a debtor to collect or compromise a Federal claim against the debtor or to consumer reporting agencies to prepare a commercial credit report for use by the FWS.

5. For individuals, personal information such as home address and telephone number, financial data, and personal identifiers (social security number, birth date, etc.) will be removed prior to any release of the application.

6. The public reporting burden on the applicant for information collection varies depending on the activity for which a permit is requested. The relevant burden for an Application to Establish a Master File for the Export of Live Captive-Bred Animals is 1 hour. This burden estimate includes time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, U.S. Fish and Wildlife Service, 5275 Leesburg Pike, MS: BPHC, Falls Church, VA 22041-3803.

Freedom of Information Act – Notice

For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we request that you identify any information that should be considered privileged and confidential business information to allow the Service to meet its responsibilities under FOIA. Confidential business information must be clearly marked "Business Confidential" at the top of the letter or page and each succeeding page and must be accompanied by a non-confidential summary of the confidential information. The non-confidential summary and remaining documents may be made available to the public under FOIA [43 CFR 2.13(c)(4), 43 CFR 2.15(d)(1)(i)].

DO NOT RETURN THIS PAGE WITH THE APPLICATION

Form 3-200-19 Rev. 04/2017 Page 9 of 9