Federal Permit Application for the Harvest of Aquacultur

Instructions for the Federal Permit Application for Aquacultured Live
Rock (new permit)
Rev 04/04/2017
In addition to the instructions provided herein, applicants with specific questions are encouraged to contact the
Permits Office at (727) 824-5326 or toll free at (877) 376-4877 between 8:00 a.m. and 4:30 p.m. ET, or visit
the SERO Permits website at sero.nmfs.noaa.gov/permits.
Please consult the U.S. Code of Federal Regulations whose guidance for application requirements, permit
eligibilities, and related information will always prevail. NMFS will return incomplete or illegible applications.
Additional guidance regarding Aquacultured Live Rock is available on the web at:
http://sero.nmfs.noaa.gov/aquaculture/

General Instructions:
Aquacultured Live Rock (ALR) permits issued to one or more permit holders allow the deposition to and
harvest of materials at a specific geographic location, or site. Use this application to request an ALR permit for
a site that has not previously been issued an ALR permit,
To renew an ALR permit issued to the same permit holder(s) and for the same site, use the application titled
Federal Permit Application for Aquacultured Live Rock (renew permit).
If you wish to apply as a new permit holder for an already existing site, see section below on how to conduct
an ALR site transfer.
Under the current agreement between NMFS and the U.S. Army Corps of Engineers (USACE), the total
acreage of all aquacultured live rock sites maintained by a single permit holder in Federal waters off the coast
of Florida may not exceed 1.0 acres. Applicants desiring to maintain sites that exceed this 1.0 acre limit must
contact their local USACE office (http://www.usace.army.mil/Locations/) and inquire about the individual
permitting process for the deposit of aquacultured live rock in Federal waters off the coast of Florida.
What Sections do I complete?
Complete all applicable sections of this application form. All application fields should be typed or printed in ink.
Specifically,
All applicants must fill out Section 1.
All applicants must fill out Section 2a. If more than one vessel will be involved in the deposition or harvest of
materials from the site, fill out Section 2b. Copy Section 2 as necessary to provide information about all vessels
that may engage in the deposition or harvesting of materials from this site.
All applicants must fill out Section 3. If the ALR permit is to be issued to one or more individuals, fill out section 5a
for each individual to whom the permit is to be issued. If the ALR permit is to be issued to one or more
businesses, fill out section 3b for each business to whom the permit is to be issued. Copy Section 3 as
necessary to provide information about each individual or business requested to be an ALR Permit Holder.
If the USCG documentation or state registration for any vessel listed in Section 2a or 2b indicates the vessel is
owned by one or more individuals, fill out Section 4 for all individual owners of the vessel(s). Copy Section 4 as
necessary to provide information about all individuals that owner the vessel(s) listed in Section 2.
If the USCG documentation or state registration for any vessel listed in Section 2a or 2b indicates the vessel is
owned by one or more businesses, fill out Section 5 for all business owners of the vessel(s). Copy Section 5 as
necessary to provide information about all individuals that owner the vessel(s) listed in Section 2.
Complete Section 6 to provide information about all businesses that own a business listed in Section 3b, Section
5a, and/or Section 5b. Copy Section 6 as necessary to provide information about all business owners within the
ownership hierarchy of businesses requesting a permit or that own a vessel listed in this application.
Complete Section 7 for all individual owners and officers of businesses listed in Section 3b, Section 5a and b, and
Section 6a and b. Copy Section 7 as necessary to provide information about all individual owners and officers of
businesses that are requesting a new permit or that own a vessel listed in this application.
Complete Section 7c if any owners of the businesses listed in Section 3b, Section 5, or Section 6 hold an
ownership percentage less than 1%. This is not common.
1

All applicants must complete Section 8 and Section 9.
See pages 3-6 for information about specific sections of this application.

What is the fee?
The application fee is $175. This application fee is collected to cover the administrative cost of processing the application,
and is non-refundable. The fee to replace a permit live rock permit is $18. NMFS will not refund money for denied permits.
A check or money order payable to the U.S. TREASURY must accompany each application.

Where do I send the application?
Mail the complete application, payment, and all required supporting documentation to: National Marine Fisheries
Service (F/SER14), 263 13th Avenue South, St. Petersburg, FL 33701. To receive permits via overnight carrier, enclose
a completed, pre-paid air bill and envelope. Please note using the prepaid overnight delivery option does not expedite
permit processing; it only expedites delivery of your completed permit package.

How do I transfer ownership of an existing Aquacultured Live Rock
If you are not the current permit holder for a particular site, you must include with this application a notarized statement
signed by you and the current owner of the site. The notarized statement must provide details on the transfer and include
the site number (e.g., AQU-XXX), latitude/longitude of the site, the full names and addresses and phone numbers of both
the transferor and transferee. Note that all deposit and harvest reports for the site must be received by the NOAA Fisheries
Permits Office and Florida Fish and Wildlife Research Institute, respectively, before the transfer can be finalized.

What supporting documentation do I need?
Documentation or state registration: Include a copy of the vessel’s valid USCG Documentation or, if not required to
be USCG Documented include a copy of the vessel’s valid State Registration, for each vessel listed in Section 4.
Payment: Include a check or money order made out to the US Treasury. See “What is the Fee” on page 1 of these
instructions for more information. Include a separate check or money order if requesting Floy tags for Golden Crab or
Sea Bass pots.
Sample Deposit Material: Provide a sample of the material to be deposited on the site for cultivation of live rock.
Nautical Chart: Applicant shall identify the site on a nautical chart, or portion thereof, with sufficient enough detail to
allow for site inspection, and shall provide accurate coordinates so that the site can be located by Global Positioning
System (GPS) equipment. The chart number, title and edition must be clearly labeled and the chart must be large
enough in scale to show sufficient detail to allow for site location and inspection.
U.S. Army Corps of Engineers Special Permit (if applicable): If the site(s) sites individually or cumulatively total
more than 1.0 acre you must include a U.S. Army Corps of Engineers (USACOE) special permit for depositing material
for the site(s).
Authorization from Florida Keys National Marine Sanctuary (if applicable). If the new site is located within the
Florida Keys National Marine Sanctuary, you must receive consent from the Florida Keys National Marine Sanctuary
(FKNMS) Permit Coordinator ([email protected], or (978) 471-9653). Provide documentation of this consent
with your application.

2

What about reporting compliance?
Deposit
Federal aquacultured live rock permit holders must report to the Permits Office after each deposition of material on a site.
Such reports must be postmarked no later than 7 days after deposition and must contain the following information:
• Permit number of site and date of deposit.
• Geological origin of material deposited.
• Amount of material deposited.
• Source of material deposited, that is, where obtained, if removed from another habitat, or from whom purchased.
The form “Report for the Deposit or Harvest of Aquacultured Live Rock” is available on our public website at
http://sero.nmfs.noaa.gov/operations_management_information_services/constituency_services_branch/permits/permit_a
pps/index.html
Harvest
If you are landing your harvested aquacultured live rock in Florida, you must report to the Fisheries Dependent
Monitoring Section of the Florida Fish and Wildlife Research Institute using standard form #33-610 (Marin Fisheries Trip
Ticket). Call the trip ticket office at (727) 896-8626 for more information.
You may use the “Report for the Deposit or Harvest of Aquacultured Live Rock” form only if you are landing harvested
aquacultured live rock outside of Florida.
NOTE: You may only conduct activity (e.g., deposition, harvest) on your site in years when you have an active federal
Aquacultured Live Rock permit.

APPLICATION SECTION 1 – SITE INFORMATION.
Complete all fields in this section.
• This section must be prepared by an independent source in a manner pursuant to generally accepted industry
standards, and shall demonstrate that the proposed site:
a)
b)
c)
d)

Is not a hazard to safe navigation or a hindrance to vessel traffic
Avoids traditional fishing operations, or other public access
Avoids impacts to naturally occurring hard bottom habitat and submerged aquatic vegetation; and
Contains natural underlying substrata that is primarily hard packed sand, hard shell hash, or less than 6-12
inches of sand over rock.
• Provide a description of the site, as requested in sections 1a – 1d.
• Provide information about the independent surveyor who performed the site inspection.
• You may provide a supplemental report by the independent surveyor if such a report augments the descriptions
in this section.

APPLICATION SECTION 2 – VESSEL INFORMATION.
Complete Section 2 for all vessels to be permitted to deposit or harvest of materials from the site. Copy this
page as necessary to provide information about all vessels.
• Enter the Official Number and the length of the vessel as they appear on the U.S. Coast Guard Certificate of
Documentation, or the State Registration certificate for a vessel without USCG documentation.
• Provide the Hull Identification Number (HIN) if available. The HIN is a unique number assigned by the boat builder.
Most HINs are shown on the state registration or USCG documentation.
• Provide hailing port or home port of the vessel in the fields provided.
• Provide information about the Port of Landing, which is where the vessel will land the harvested aquacultured live
rock, in the fields provided.
• For USCG documented vessels, provide the gross and net tonnage in the fields provided.
• Provide information about the vessel’s physical characteristics in the fields provided.

3

APPLICATION SECTION 3 – PERMIT HOLDER INFORMATION.
Provide information about the individual(s) or business(es) to be listed as the permit holder. For individual
permit holders, fill out section 3a. For business permit holders, complete Section 3b. If there is more than
one permit holder, select a single Primary Mailing Recipient to whom all correspondence about this application
and requested permits will be sent. Copy Section 3 as necessary to provide information about all individuals and
businesses to be a permit holder. Specifically,
Section 3a
• For each individual permit holder, include the lessee’s full name, tax ID number (SSN), date of birth, phone
number, physical address, mailing address, sex, and race/ethnicity information.
• Indicate if the Individual is a United States citizen or permanent resident alien. Note, this information will not
affect eligibility to obtain a permit.
• Provide an email address or SMS mobile phone number to receive digital updates about your permit and
application status (when available).
Section 3b
• For each business that leases the vessel, provide the business’s full name, tax ID number (FEIN), date the
business was formed, phone number, physical address, mailing address, and business type.
• Indicate if the business was established by the laws of the United States or any state of the United States. Note,
this information will not affect eligibility to obtain a permit.
• Provide an email address or SMS mobile phone number to receive digital updates about your permit and
application status (when available).
• For a brief definition of applicable business types, see our frequently asked questions at
http://sero.nmfs.noaa.gov/operations_management_information_services/constituency_services_branch/permits/
permit_faq/index.html

APPLICATION SECTION 4 -- INDIVIDUAL VESSEL OWNERS.
For each vessel listed in Section 2 that is owned by one or more individuals (as listed on the vessel’s U.S.
Coast Guard Certificate of Documentation or State Registration), complete Section 4 for all individual owners
listed. Complete Section 4a for an individual owner. Also fill out Section 4b if the vessel is jointly owned
by another individual. Photocopy Section 4 as necessary to provide information for all individuals that own
the vessel.
• For each owner, provide the owner’s full name, tax ID number (SSN), date of birth, phone number, physical and
mailing address, sex, and race/ethnicity information.
• Indicate if the owner is a United States citizen or permanent resident alien. Note, this information will not affect
eligibility to obtain a permit.
• Provide an email address or SMS mobile phone number to receive digital updates about your permit and
application status (when available).

APPLICATION SECTION 5 – BUSINESS VESSEL OWNERS.
For each vessel listed in Section 2 that is owned by one or more businesses (as listed on the vessel’s U.S.
Coast Guard Certificate of Documentation or State Registration),complete section 5 for all business owners
listed. Complete section 5a for a single business owner. Also fill out Section 5b if the vessel is jointly
owned by another business.
• NMFS will not issue permits to a business with an INACTIVE status with the applicable Secretary of State.
• Provide the business’s full name, tax ID number (FEIN), date the business was formed, phone number, physical
and mailing address, and business type.
• Indicate if the business was established by the laws of the United States or any state of the United States. Note,
this information will not affect eligibility to obtain a permit.
• Provide an email address or SMS mobile phone number to receive digital updates about your permit and
application status (when available).
• For a brief definition of applicable business types, see our frequently asked questions at
http://sero.nmfs.noaa.gov/operations_management_information_services/constituency_services_branch/permits/
permit_faq/index.html

4

Company A

Company B

APPLICATION SECTION 6 –Businesses that Own Businesses
Complete this section for any business that owns more than 1% of any business listed within the
ownership hierarchy of vessel owners or permit holders, as listed in Section 3b, or Section 5. For every
business, the sum of ownership, by either individuals or other businesses, must total 100%. Photocopy
this section as necessary to provide information about all businesses within the ownership hierarchy
of the vessel.

• For each business, provide the business’s full name, tax ID number (FEIN), date the business was
formed, phone number, physical and mailing address, and business type.
• Indicate if the business was established by the laws of the United States or any state of the United
States. Note, this information will not affect eligibility to obtain a permit.
• Provide an email address or SMS mobile phone number to receive digital updates about your permit and
application status (when available).
• For a brief definition of applicable business types, see our frequently asked questions at
http://sero.nmfs.noaa.gov/operations_management_information_services/constituency_services_branch/permits/
permit_faq/index.html
Example: If a vessel’s USCG documentation indicates that the vessel is owned by Company A, and Company A
is owned by Company B. Provide information about Company A in section 5 and Company B in section 7.
APPLICATION SECTION 7 –Businesses Officers and Individual Owners
Complete this section for any individual that owns more than 1% of any business listed in Section 3b,
Section 5, or Section 6. For every business, the sum of ownership, by either individuals or other
businesses, must total 100%. Photocopy this section as necessary to provide information about all
businesses within the ownership hierarchy of the vessel
• For each individual owner or officer, include the entity’s full name, tax ID number (SSN), date of birth, phone
number, physical address, mailing address, sex, and race/ethnicity information.
• Indicate if the individual is a United States citizen or permanent resident alien. Note, this information will not
affect eligibility to obtain a permit.
• Provide an email address or SMS mobile phone number to receive digital updates about your permit and
application status (when available).
Example: If a vessel’s USCG documentation indicates that the vessel is owned by Company A, provide
information about all owners and officers of Company A. If Company A is also owned in whole or part by
Company B, complete section 8 to provide information about all individual owners and officers of Company A and
Company B.
Photocopy this section as necessary to provide information about all businesses and their respective owners and
officers that comprise the ownership hierarchy of the vessel.
Minor shareholders

Section 7C is left blank for most applicants. Complete Section 7C if a business listed in Section 3b, 5, 6, or 7 has
owners that individually own less than 1% of the business. Provide the total percentage of ownership which is
individually held by owners who own less than 1%.
APPLICATION SECTION 8 – Small Business or Organization Certification
This section is required for ALL applicants. Review the business/organization descriptions in the boxes directly under
the word “START”, and identify the one that describes the applicant’s primary activity. Then answer the questions in
the box to the right of the business activity you selected.
If you have questions about these standards or the definition of affiliation, please call Southeast Regional
Economist Mike Travis at 727-209-5982.

APPLICATION SECTION 9 – SIGNATURE FOR APPLICATION
The signator for a coral permit must be the individual who will be conducting the activity that requires the
permit. In the case of a corporation or partnership that will be conducting live rock aquaculture activity, the
signator must be the principal shareholder or a general partner.

5

KNOWINGLY SUPPLYING FALSE INFORMATION OR WILLFULLY OVERVALUING ANY FISHING INCOME TO OBTAIN A
PERMIT IS A VIOLATION OF FEDERAL LAW PUNISHABLE BY A FINE AND/OR IMPRISONMENT.
Public reporting burden for this collection of information is estimated to average 70 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, Vessel length, Vessel tonnage (gross and net), Vessel horse power, 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.

6

OMB Control Number 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)
sero.nmfs.noaa.gov/permits

FEDERAL PERMIT APPLICATION FOR
AQUACULTURED LIVE ROCK (NEW)
FOR OFFICE USE ONLY
Reviewer Initials and date
Check or Money Order
Number and Amount
New Site Number

FOR OFFICE USE ONLY

Expiration date

Application ID

Application Fees:

New: $175

SCAN DATE AND INITIALS

SECTION 1 - SITE INFORMATION
Is this a new or established site?

New

Established

NMFS Site number: AQU-

If this is a new site,
leave blank—NMFS
will assign a number.

NOTE: If this is an established site and the applicant is not the current permit holder, the applicant must complete the site transfer requirements
outlined in the instructions.
Site Location:
Latitude and Longitude must be reported as Degrees-Minutes to the third decimal place (i.e. 24-32.123 N 085-45.456 W)

Longitude Center Point

Latitude Center Point
Method of determining latitude and longitude

GPS

DGPS

This site is located off the state of:

Radius ( not to exceed 117.75 feet )

Ft.

Minimum depth of water over the site at mean
low water - reported in feet.

Ft.

SITE SURVEY REQUIREMENTS
1a. Description of the site location (i.e. 5.5NM SW of Rock key and .75NM east of Sand Shoal)

1b. Describe the naturally occurring bottom habitat at the site:

1

ASE2017.7P; Form Revision 03/21/2017

SECTION 1 - SITE SURVEY REQUIREMENT (continued)
1c. Describe all possible hazards to safe navigation or hindrance to vessel traffic, interference with traditional fishing operations or other public access that may
result from aquacultured live rock operations at the site.

1d. Describe the type, size, total amount and geological origin of the material to be deposited on the site and how it will be distinguishable (method of marking/
tagging) and description) from the naturally occurring substrate. YOU MUST PROVIDE A SAMPLE OF THE MATERIAL.

SURVEYOR INFORMATION
Company Name

Mailing Address

Area Code

Apt #

City

State

Phone Number

County/Parish

Zip Code

I Certify that this survey information is true and correct to the best of my training, education and ability.
Date Signed

Surveyor Signature

Position in Company

Printed Name
Qualifications/experience of Surveyor:

2

Country

SECTION 2 - VESSEL INFORMATION
Copy this page as needed to provide information for each vessel that is designated to deposit or harvest of live rock material. A vessel may not
be used for depositing or harvesting of material if it is not included on the application.

SECTION 2a - Primary Vessel Information
Official Number From USCG Certificate Of Documentation

State Registration Number (as applicable)

Vessel Name

Year Built

Hull Identification Number

Length (ft)

Crew Size - Including the Captain
HOLD or FISH BOX CAPACITY: How many pounds
of product can you bring to the dock when full?

Hailing Port City

Hailing Port County Or Parish

Hailing Port State

Port of Landing City

Port of Landing State

LIVE WELL CAPACITY: How many gallons of water
does your live well hold?
Hull Material
FIBERGLASS
STEEL

USCG DOCUMENTED VESSELS ONLY
Gross Tons

Total Horsepower

Net Tons

Fuel Data
DIESEL

Fuel Capacity Total Gallons

GASOLINE

WOOD

OTHER
(DESCRIBE)

CEMENT

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

OTHER
(DESCRIBE)

SECTION 2b - Additional Vessel Information
Official Number From USCG Certificate Of Documentation

State Registration Number (as applicable)

Vessel Name

Year Built

Hull Identification Number

Length (ft)

Crew Size - Including the Captain
HOLD or FISH BOX CAPACITY: How many pounds
of product can you bring to the dock when full?

Hailing Port City

Hailing Port County Or Parish

Hailing Port State

Port of Landing City

Port of Landing State

LIVE WELL CAPACITY: How many gallons of water
does your live well hold?
Hull Material
FIBERGLASS
STEEL

USCG DOCUMENTED VESSELS ONLY
Gross Tons

Total Horsepower

Net Tons

WOOD
CEMENT

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

OTHER
(DESCRIBE)

3

Fuel Data
DIESEL
GASOLINE
OTHER
(DESCRIBE)

Fuel Capacity Total Gallons

SECTION 3 - PERMIT HOLDER INFORMATION
Complete Section 3a on this page for an individual that is requesting an Aquacultured Live Rock Permit. Complete section 3b for a business that
is requesting an Aquacultured Live Rock Permit. Photocopy this page as needed to provide information on all permit holders. Select only ONE
mailing recipient.
Section 3a: Complete this section for an individual requesting an Aquacultured Live Rock Permit.

What this individual’s
Sex?
What is this
individual’s
race?

Male

Is this Individual of Hispanic, Latino, or Spanish origin?

Female

YES

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

MAILING RECIPIENT - All mail about this permit
will go to the individual listed in Section 3a

No

Yes

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Last Name

NO

Suffix - Jr, Sr, etc.

Middle Name

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 #

Area Code

City

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

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

Cell Phone number and provider:

Email

Section 3b: Complete this section for a business requesting an Aquacultured Live Rock Permit.

Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

MAILING RECIPIENT - All mail about this permit
will go to the individual listed in Section 3b
Registered Name of Business

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)

Apt #

City

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

Email

Cell Phone number and
provider:

4

YES
NO

SECTION 4 - INDIVIDUAL VESSEL OWNER(S) INFORMATION
Photocopy this page as needed to provide ownership
information for all vessels listed in section 2. Use a separate
page for each vessel.

Vessel Number (USCG or State number)

Section 4a: Primary or Sole Owner: Complete this section if there is one or more individual shown on the USCG documentation, State
Registration or title as the registered joint owner of the vessel.
Is this individual a United States Citizen
or permanent resident alien?
What this individual’s
Sex?
What is this
individual’s
race?

Male

Is this Individual of Hispanic, Latino, or Spanish origin?

Female

YES
No

Yes

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Last Name

Tax ID Number (SSN)

Middle Name

Date of Birth (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

NO

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

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

Cell Phone number and provider:

Email

Section 4b: Joint Owner. Complete this section if there is more than one individual shown on the USCG documentation, State Registration or title
as the registered owner of the vessel. Copy this page as needed to include ALL owners of the vessel.
Is this individual a United States Citizen
or permanent resident alien?
What this individual’s
Sex?
What is this
individual’s
race?

Male

Is this Individual of Hispanic, Latino, or Spanish origin?

Female

YES

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

Tax ID Number (SSN)

Mailing Address

Middle Name

First Name

Date of Birth (MM/DD/YYYY)

Apt #

City

Area Code

No

Yes

White

NO

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

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

Cell Phone number and provider:

Email

5

SECTION 5 –BUSINESS VESSEL OWNER(S) INFORMATION
Photocopy this page as needed to provide ownership
information for all vessels listed in section 2.

Vessel Number (USCG or State number)

Section 5a: Primary or Sole Owner: Complete this section if there is one or more businesses shown on the USCG Documentation, State
Registration or Title as the registered owner of the vessel. Select only ONE mailing recipient. Photocopy this section as necessary to

provide information about all businesses that own the vessel, or are owners of other businesses that own the vessel.
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

YES
NO

Registered Name of Business

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

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

Email

Cell Phone number and provider:

Section 5b: 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. Photocopy this section as necessary to provide information about all businesses that own the
vessel, or are owners of other businesses that own the vessel.
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

Registered Name of Business

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)

Apt #

City

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

Email

Cell Phone number and provider:

6

YES
NO

SECTION 6 - BUSINESSES THAT OWN BUSINESSES
Complete this section for each business that owns 1% or more of a business listed in sections 3b and 4b. Copy this section as needed.

Section 6a: Business owner:

Business for which this business is an owner of:
Percent of Business Owned:
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

YES
NO

Registered Name of Business

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

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

Cell Phone number and provider:

Email

Section 6b: Additional Business owner:

Business for which this business is an owner of:
Percent of Business Owned:
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

Registered Name of Business

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)

Apt #

City

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

Email

Cell Phone number and provider:

7

YES
NO

SECTION 7 - BUSINESS OFFICERS AND INDIVIDUAL OWNER
Complete this section by providing information on all individual officers and owners that own 1% or more of any business listed in sections 3b, 5, and 6. Copy this
section as needed.

Section 7a: Individual Officer/Owner:
Business for which this individual is an officer/owner of:
Position Held - Check ALL That Apply
Vice President
President/CEO
Percent of Business Owned:
What this individual’s
Sex?
What is this
individual’s
race?

Male

Secretary

Treasurer

Director/ Manager

Shareholder

Other
YES

Is this individual a United States citizen or permanent resident
Is this Individual of Hispanic, Latino, or Spanish origin?

Female

No

Yes

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)

Date of Birth (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

NO

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

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

Cell Phone number and provider:

Email
Section 7b: Additional Officer/Owner:
Business for which this individual is an officer/owner of:
Position Held - Check ALL That Apply
President/CEO

Vice President

Percent of Business Owned:
What this individual’s
Sex?
What is this
individual’s
race?

Male

Secretary

Treasurer

Director/ Manager

Shareholder

Other
YES

Is this individual a United States citizen or permanent resident
Is this Individual of Hispanic, Latino, or Spanish origin?

Female

White
Black or African American

Last Name

Tax ID Number (SSN)

Mailing Address

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander
Other _______________

Asian American

Middle Name

First Name

Date of Birth (MM/DD/YYYY)

Apt #

City

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

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

Email

Cell Phone number and provider:

8

NO
No

SECTION 7 - OFFICER/OWNER INFORMATION FOR BUSINESS(ES) THAT OWN THE VESSEL (cont.)
7c. Minor Owner Information
MINOR OWNERS - Check here if one or more owners individually holds shares that is less than 1% of the total business shares.
TOTAL PERCENTAGE of the business shares held by minor owners.

SECTION 8 - SMALL BUSINESS OR ORGANIZATION CERTIFICATION

(All Applicants must complete this section)
Complete this section for the business(es)/organization(s)/ sole proprietorship(s) listed in section 5 to whom the permit will be issued.
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 and non-profit organizations). As part of the required analyses, NMFS must determine if permit applicants are large or small entities according
to standards established by the Small Business Administration (SBA) and NMFS. Only one standard applies to each business or non-profit organization. The
standard is based on your primary North American Industry Classification System (NAICS) code, which indicates the industry your business or non-profit organization is primarily engaged in. The industry you are primarily engaged in is based on the activity that generated the greatest gross receipts (sales) in the most
recent calendar year. The SBA has also established “principles of affiliation” to determine whether a business concern is “independently owned and operated.”
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.
For this assessment, please estimate your annual gross receipts (sales) OR number of employees (see chart below to determine which estimate you need).
Estimates of annual gross receipts must be for all businesses with which you are affiliated. Estimates of the number of employees must include all full, part-time,
and temporary employees of all businesses with which you are affiliated. For example, if two businesses jointly own or lease a vessel, it is highly likely they are
affiliated. If you have any questions about affiliation, please contact Mike Travis, SERO Economist, at [email protected] or call 727-209-5982.
Please base your responses on the most recent calendar year for which you have complete data regarding your business’ or organization’s operations, and
specify that calendar year in the appropriate box below

START
1 Is the business primarily involved in harvesting

Yes

seafood (commercial Fishing)?

Did the business have more than $11 million in annual gross receipts?
Yes

No

You are done.

Year

No
2 Is the business primarily involved in For-hire fishing

Yes

Did the business have more than $11 million in annual gross receipts?
You are done.
Year
Yes
No

Yes

Did the business have more than 100 employees?

services (charter, party/headboat)?

No
3 Is the business primarily involved in Buying and
selling seafood (seafood dealer/wholesaler)?

Yes

No

Year

You are done.

No
4

Is the business primarily involved in processing seafood (seafood processor)?

Yes

Did the business have more than 750 employees?
Yes

No

You are done.

Year

No
5

Is the organization an Environmental Conservation and
Wildlife, or Professional Non-Profit Organization?

Yes

Did the business have more than $15 million in annual gross receipts?
Yes

No

You are done.

Year

No
6

Is the organization some other Non-Profit Organization
(e.g. business association)?

Yes

Did the business have more than $7.5 million in annual gross receipts?
Yes

No

You are done.

Year

No
7

Then the business
must be primarily
involved in another
industry not related
to fishing or seafood.

Based on the applicable SBA size standard, check the appropriate box
to indicate if the business is a Large or Small business.

Refer to SBA’s list if NAICS
codes (See http://
go.usa.gov/cs3jj) and
enter your primary NAICS
code here:

Large

9

Small

Year

You are done
Revised 03/13/2017

SECTION 9 —APPLICANT SIGNATURE — I certify that the information provided is complete and correct.
Date Signed

Applicant Signature

Position in Company

Printed Name

10