Report for the Deposit or Harvest of Aquacultured Live R

U.S. DEPT OF COMMERCE, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13TH Avenue South
St. Petersburg, FL 33701
Toll Free 877/376-4877 9:00 am - 4:00 pm ET
727/824-5326 (9:00 am - 4:00 pm ET)
https://www.fisheries.noaa.gov/permits-and-forms

REPORT FOR THE DEPOSIT OR
HARVEST OF AQUACULTURED LIVE
ROCK

OMB Control No. 0648-205;
Expiration Date: 05/31/2020

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

DEP2019.1P, Form Revision 07/16/2019

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.
For Privacy Act information related to SERO Permits and Permit Applications go to goo.gl/1Zwvbh.