Form 3-200-88 Application - Export of Pre-Convention, Pre-Act, or Anti

FWS Form 3-200-88 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

EXPORT OF PRE-CONVENTION, PRE-ACT, OR ANTIQUE MUSICAL
INSTRUMENT/TRAVELING EXHIBITION CERTIFICATE (MMPA, ESA, and/or CITES)
☐New

☐Reissue/Renew ☐Amendment

Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C.**
A. Complete if applying as an individual
1.a. Last name
2 Date of birth
(mm/dd/yyyy)

5.a. Telephone number

1.b. First name
5.b. Alternate telephone
number

1.c. Middle name or initial

1.d. Suffix

6. 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.a. Description of business, agency, Tribe, or institution

4.a. Principal officer (P.O.) last name 4.b. P.O. first name

4.c. P.O. middle initial

5. Primary contact name

6. Primary e-mail address

7.a. Business telephone number

7.b. Alternate phone no.

3.b. Website URL (if applicable)
4.b. P.O. Title

8.a. Primary contact telephone no.

C. All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
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

D.

2.c. State

2.d. Zip code/Postal code

2.e. County/Province

2.f. Country

All applicants MUST complete
1. Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, a nonrefundable processing fee (see the fee
schedule). 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.
3.

If you are requesting a reissue/renew/amendment, what is your permit/file number?
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.

The individual/principal officer of the business must print and sign the application. (No photocopied or stamped signatures)

Date (mm/dd/yyyy)

** Click here for additional instructions on completing the above form (link to instruction page). See the last page for information on the Privacy Act,
Paperwork Reduction Act, Estimated Burden, and Freedom of Information Act aspects of this application form.
Mail your application(s) to Division of Management Authority, Branch of Permits, MS:IA 5275 Leesburg Pike, Falls Church, VA 22041-3803.
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FWS Form 3-200-88 (Rev. 01/2020)
U.S. Department of the Interior

E.

OMB Control No. 1018-0093
Expires ##/##/####

Export of Pre-Convention, Pre-Act, or Antique Musical Instrument/Traveling Exhibition
Certificate (MMPA, ESA, and/or CITES)
Description
pre-Convention
(CITES)

Applicable Date
Specimen was acquired (removed from the wild or born or propagated in a controlled
environment) before the date CITES applied to it. The CITES listing date can be found at
http://www.cites.org.
pre-Act
Specimen was held in a controlled environment on or before (a) December 28, 1973 or the date
(ESA)
when the species was listed under the ESA, and (b) the holding or use was not in the course of a
commercial activity (e.g., it has not been bought, sold, or offered for sale by you or anyone else)
since December 28, 1973, or the date when listed under the ESA.
Antique
Specimen is not less than 100 years old ago, has not been repaired or modified on or after
(ESA)
December 28, 1973 with any part of any species protected by ESA and a) has entered at a port 1
designated for the import of ESA antiques or b) there is documented proof that the specimen
was in the United States prior to September 22, 1982.
pre-MMPA
Specimen was taken prior to December 21, 1972.
CITES - Convention on International Trade in Endangered Species of Wild Fauna and Flora
MMPA – Marine Mammal Protection Act
Act or ESA – Endangered Species Act
Note: This form is used to request a passport-like certificate for musical instruments. Your primary residence must be in
the United States (i.e., you reside in the United States for the majority of the year) to be eligible for this certificate.
Certificates issued may be valid for up to three years, and are intended for multiple border crossings for non-commercial
purposes (e.g., the instrument is not being offered for sale or being sold while outside the United States).
Please review our webpages “What Can I Do With My Ivory?” and “Musical Instruments” for important guidance and
reminders.
Complete all questions on the application. Mark questions that are not applicable with "N/A". If needed, use separate
sheets of paper. On all attachments or separate sheets you submit, indicate the application question number you are
addressing.
Note: African elephant ivory removed from the wild after February 4, 1977, is not considered to be PreConvention; and worked African elephant ivory may only be re-exported for non-commercial purposes (e.g., you
cannot sell the ivory once exported).
Electronic submission of inventories, photographs, and receipts/invoices: If you wish to provide information electronically,
please include a flash drive containing your information with your physical application.
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.

1 U.S. Customs and Border Protection (CBP) designated 13 ports for the entry of antiques made of ESA-listed species on September 22, 1982 (19
C.F.R. 12.26). The following ports are authorized: Boston, Massachusetts; New York, New York; Baltimore, Maryland; Philadelphia, Pennsylvania;
Miami, Florida; San Juan, Puerto Rico; New Orleans, Louisiana; Houston, Texas; Los Angeles, California; San Francisco, California; Anchorage, Alaska;
Honolulu, Hawaii; and Chicago, Illinois.

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FWS Form 3-200-88 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

2. Who 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. This application can be used to:
___ New musical instrument certificate
___ Renewal or Amendment of a current Certificate, #__________
5. For EACH musical instrument, please provide the following:
a.

Scientific name (genus, species and, if applicable, subspecies) and common name of all CITES-listed
plants or animals used to manufacture the instrument;

b.

Description of item (e.g., published description from a catalog or art book) and size (in metric units);

c.

Date of manufacture;

d.

Date of acquisition and corresponding documentation or other information on how the specimen was
acquired (e.g., bill of sale, U.S. Customs import declaration, transfer documents).

e.

If the instrument was imported into the United States after 1975, provide:
i.

A copy of canceled CITES export or re-export document issued by the appropriate CITES office
in the country from which the wildlife was imported; and

ii.

Cleared Wildlife Declaration for Import form 3-177 (hard copy or electronic release) if the
instrument contains wildlife species; or

iii.

Cleared import documentation from the Department of Agriculture or Department of Homeland
Security if the instrument contains plant species.

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FWS Form 3-200-88 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

6. Provide the current location of specimen(s) (address and country):
Name:
Address:
City, State/Province:
County, Postal Code:
7. What is the purpose of the export? Please select:
____ Personal ____ Performance ____ Other (specify: __________________)
____ Display ____ Competition
8. Provide documents, signed statement, or other documentation that the instrument(s) was obtained or
manufactured prior to the date CITES applied to the material used to manufacture the instrument (e.g., bill of
sale, appraiser’s statement, USDA or foreign phytosanitary certificate). The listing date can be found in the
CITES Species Database or you can contact the Division of Management Authority.
9. For specimens(s) protected under the U.S. Endangered Species Act (ESA), provide one of the following:
For Antiques (see definition above):
a.

Provide documentation which shows the age OR a statement from a qualified appraiser attesting
to the age; AND

b.

Signed statement that the item has not been repaired or modified on or after December 28, 1973
with any part of any species protected by ESA.

For the export of all other items that are less than 100 years old (see pre-Act definition above) and that
are not African elephant ivory:
Has this item entered into commerce (e.g., been bought, sold, or offered for sale by you or anyone else)
since December 28, 1973?
Yes ______ No ______.
If Yes, there may be a need for additional information- the Division of Management Authority will contact
you directly.
If No, sign the following certification statement:
CERTIFICATION STATEMENT (Original Signature is required)
I certify to the best of my knowledge and belief that the endangered or threatened wildlife used to
manufacture the musical instruments identified above was 1) held in captivity or in a controlled
environment on December 28, 1973, or the species listing date, if later; 2) that the purposes of such
holding were not contrary to the purposes of the Act; and 3) that the wildlife was not held in the course of
a commercial activity.
Applicant's signature: _______________________________________ Date: ____________________
10. If the specimen is protected under the Marine Mammal Protection Act, provide an affidavit and supporting
documentation that the item was taken prior to December 21, 1972 as outlined in 50 CFR 18.14. For
cetacean (whales) and pinniped (seals and seal lions; not walrus) specimens, provide either a copy of NOAA
Fisheries letter of authorization or evidence that NOAA Fisheries has been contacted.
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FWS Form 3-200-88 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

11. Please note that you may need to obtain additional authorizations required under State, Tribal, Federal, or
foreign government for the activities that you want to conduct. While the Service will assist you where we can
with these additional authorizations, it is your responsibility to obtain all required authorizations. If you have
questions, please call the Division of Management Authority.
All instruments that contain wildlife specimens must be declared to the U.S. Fish and Wildlife Service
Wildlife Inspectors at time of export/re-export. Likewise, the Department of Agriculture must inspect all
instruments that contain CITES-listed plant species. Please indicate which U.S. port(s) you will be
traveling through. The Service will assist you in contacting the appropriate border officials.

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FWS Form 3-200-88 (Rev. 01/2020)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires ##/##/####

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the following: the Bald and Golden Eagle Protection Act (16
U.S.C. 668), 50 CFR 22; the Endangered Species Act (16 U.S.C. 1531-1544), 50 CFR 17; the Migratory Bird Treaty Act
(16 U.S.C. 703-712), 50 CFR 21; the Marine Mammal Protection Act (16 U.S.C. 1361, et seq.), 50 CFR 18; the Wild Bird
Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15; the Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16;
Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), 50 CFR 23; General
Provisions, 50 CFR 10; General Permit Procedures, 50 CFR 13; and Wildlife Provisions (Import/export/transport), 50 CFR
14.
Purpose: The collection of contact information is to verify the individual has an eligible permit to conduct activities which
affect protected species. This helps FWS monitor and report on protected species and assess the impact of permitted
activities on the conservation and management of species and their habitats.
Routine Uses: The collected information may be used to verify an applicant’s eligibility for a permit to conduct activities
with protected wildlife; to provide the public and the permittees with permit related information; to monitor activities under
a permit; to analyze data and produce reports to monitor the use of protected wildlife; to assess the impact of permitted
activities on the conservation and management of protected species and their habitats; and to evaluate the effectiveness
of the permit programs. More information about routine uses can be found in the System of Records Notice, Permits
System, FWS-21.
Disclosure: The information requested in this form is voluntary. However, submission of requested information is
required to process applications for permits authorized under the listed authorities. Failure to provide the requested
information may be sufficient cause for the U.S. Fish & Wildlife Service to deny the request.
PAPERWORK REDUCTION ACT STATEMENT
We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) in order provide the U.S. Fish
and Wildlife Service the information necessary, under the applicable laws governing the requested activity, for which a
permit is requested. 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 applicable laws. Failure to provide all
requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. According to the
Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of
information and assigned Control No. 1018-0093.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information averages:
Original submission - paper-based: 1 hour 30 minutes
Amended submission - paper-based: 1 hour 15 minutes
Original submission - electronic: 1 hour 15 minutes
Amended submission - electronic: 1 hour
These estimates include time for reviewing instructions, gathering and maintaining data and completing and reviewing the
form. Direct comments regarding the burden estimate or any other aspect of the form to the Service Information
Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB/PERMA
(JAO), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this
address.

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