Dealer Permit Application Form - Initial and Renewal

98

Federal Greater Atlantic Seafood Dealer

Initial Dealer Permit Application

All corporations, LLCs, and partnerships must provide a copy of the Certificate of Incor- poration listing the names of all partners, officers, and/or share-

holders in the company. Failure to provide this information MAY DELAY the processing of your application.

SECTION 1 ‑ DEALER INFORMATION

Company name: __

Owner’s Name: ____

Mailing Address:_________________________________

City: State: Zip Code: ___

Telephone: Fax Number: ___

**Vessel Name: ___ **Vessel Hull Number:_____________

**(if you are applying for an Atlantic Mackerel at Sea Processor permit or an Atlantic Herring at Sea Processor permit, you must enter a vessel name and hull number above and include a copy of the vessel’s current Coast Guard Documentation or State Registration.)

If regulated species are purchased or received for commercial purposes at more than one place of business, each address must be listed. List those additional addresses on the back of this form in Section 1A.

SECTION 2 - FISHERIES

Select the fisheries desired by placing an (X) in the boxes provided. Select all fisheries that apply.

	Atlantic bluefin tuna			Northeast multispecies			Scup
	Other Atlantic Tunas (Yellowfin, Bigeye, Skipjack,			American lobster			Black sea bass
	Albacore)			Skate			Monkfish
	Surfclam/Ocean quahog - Dealer			**Atlantic mackerel at sea processor			Atlantic bluefish
	Surfclam/Ocean quahog - Processor			Squid, Atlantic mackerel, butterfish			Spiny Dogfish
	Summer flounder			Atlantic herring - Dealer			Tilefish
	Atlantic sea scallop			**Atlantic herring At Sea Processor			Atlantic Deep-sea Red Crab
	Atlantic Hagfish			** Atlantic herring At Sea Dealer (Carrier)			Jonah Crab

SECTION 3 ‑ OWNER'S NAME AND SIGNATURE

I affirm, subject to the penalties provided in 18 USC 1001, that all information I have given in obtaining this permit is true and correct.

Print Name: __________________________

Signature: Date: _________________

Revised 3/10/2014 OMB# 0648-0202 Expiration Date: 07/31/2016

SECTION 1A - ADDITIONAL DEALER INFORMATION. If regulated species are purchased or received for commercial purposes at more than one place of business, each address must be listed below.

Company Address

Street:

City: State: Zip:

Telephone:

Company Address

Street:

City: State: Zip:

Telephone:

Company Address

Street:

City: State: Zip:

Telephone:

Company Address

Street:

City: State: Zip:

Telephone:

For further information, call the Greater Atlantic Region Permit Office at (978) 282-8438.

The information requested on this form is not confidential and will be available to the general public upon request.

The Paperwork Reduction Act requires potential respondents for a dealer/processor permit be notified of certain information regarding their rights and the burden associated with applying for a Federal dealer/processor permit. One of the regulatory steps taken by the National Marine Fisheries Service (NMFS) to carry out conservation and management objectives is the requirement of a permit for users of the resources. All the fisheries included on this application require a permit to purchase, or otherwise receive for transport for a commercial purpose, other than solely for transport on land, species harvested by the owner or operator of a fishing vessel issued a Federal fisheries permit for these species. Section 303(b)(1) of the Magnuson-Stevens Fishery Conservation and Management Act (MSFCMA) specifically recognizes the need for permit issuance.

The purpose and use of permits is to: (1) register fish dealers and processor, (2) list the characteristics of dealer/processor operations, (3) exercise influence over compliance (e.g. withhold issuance pending collection of unpaid penalties and / or required reports), (4) provide a mailing list for the dissemination of important information to the industry, (5) provide a universe for data collection samples, and (6) obtain first purchase information on landings to evaluate the biological, economic and social implications of management measures.

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject 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. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the information. Send comments regarding this burden estimate or suggestions for reducing this burden to: National Marine Fisheries Service, Permit Office, 55 Great Republic Drive, Gloucester, MA 01930‑2276.

Revised 11/18/2013 OMB# 0648-0202 Expiration Date: 07/31/2016