Aquacultured Live Rock Deposit Harvest Report

U.S. DEPT OF COMMERCE, NOAA
NMFS PERMITS OFFICE, F/SER14

REPORT FOR THE DEPOSIT OR
HARVEST OF AQUACULTURED LIVE
ROCK

263 13TH Avenue South
St. Petersburg, FL 33701
Toll Free 877/376-4877 8:00 am - 4:30 pm ET

OMB Control No. 0648-205;
Expiration Date: 04/30/2017
Form revised 10/15/2014

727/824-5326 (8:00 am - 4:30 pm ET)
sero.nmfs.noaa.gov/permits

FOR OFFICE USE ONLY
Reviewer Initials and
Date Entered

INSTRUCTIONS: Complete section 1 and either section 2 or 3 with all information. Please sign, date, and print your name in
section 4. You must fill out a seperate report for each deposit or harvest activity. Do not list deposits or harvests done on the
same date on the same report. You must make a seperate report for each deposit of materials that are from different sources,
suppliers and/or geographic origin, even if made on the same date.
1. PERMIT HOLDER INFORMATION
Permit holder as shown on the permit

Site number the material was
deposited to or harvested from

AQU2. DEPOSIT INFORMATION

Name of the source/supplier of the deposited material

Mailing Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Physical Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Check box if same as Mailing Address

Geographic origin of the deposited material

Date Deposited (dd/mm/yyyy)

Average Dimensions (inches) ( e.g. 12" x 12")

Total Weight Deposited (Pounds)

3. HARVEST INFORMATION - FILL OUT ONLY IF LANDED OUTSIDE THE STATE OF FLORIDA

NOTE: If landing INSIDE the state of Florida, you must report to the Fisheries Department Monitoring Section of the Florida Fish and Wildlife Research
Institute using standard form #33-610 (Marine Fisheries Trip Ticket). Call the trip ticket office at 727/896-8626 for more information.
Name of the purchaser of the harvested material

Mailing Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Physical Address

Apt/Suite #

City

State

County/parish

Zip Code

Country

Check box if same as Mailing Address

Date Harvested (mm/dd/yy)

Total Weight Harvested (pounds)

Price Per Pound

Total Dollar Value

4. SIGNATURE
SIGNATURE

PRINTED NAME

POSITION IN COMPANY

DATE

Public reporting burden for this collection of information is estimated to average 15 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/SER2, 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. Confidential name and address information will be released via a NOAA Fisheries website. 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.