Federal Permit Application for Vessels Fishing in the Co

Instructions for the Federal Permit Application for Vessels
Fishing in the Colombian Treaty Waters

Rev 05/11/2020

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 9:00 a.m. and 4:00 p.m. ET, or visit
the SERO Permits website at https://www.fisheries.noaa.gov/permits-and-forms.
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.

General Instructions:
What Sections do I complete?
Complete all applicable sections of this form. All application fields should be typed or printed in ink. Specifically,
All applicants must fill out Section 1, and Section 2 and/or Section 3.
If the vessel’s USCG documentation or state registration indicates the vessel is owned by one or more individuals,
fill out Section 3.
If the vessel’s USCG documentation or state registration indicates the vessel is owned by one or more
businesses, fill out Section 4.
If the vessel is leased and the permit(s) will be issued to the lessee(s), complete Section 5.
If the vessel is owned by a business which is owned by another business, in addition to completing Section 5,
complete Section 6. In Section 6, provide information about all businesses that are parent companies of
businesses that own the vessel.
If the vessel is leased by a business which is owned by another business, in addition to completing Section 5,
complete Section 6. In Section 6, provide information about all businesses that are parent companies of
businesses that lease the vessel.
If the vessel is owned or leased by a business, in addition to completing Section 4 and/or 5, complete Section 7.
In Section 7, provide information about all individuals that are owners or officers of businesses listed in Section 4,
Section 5, and/or Section 6.
Complete Section 8 if the any owners of the businesses listed in Section 4, Section 5, or Section 6 hold an
ownership percentage less than 1%. This is not common.
All applicants must fill out Section 9.
See pages 3-6 for information about specific sections of this application.

What is the fee?
There is no fee for a Colombian Treaty Water permit

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.

What about reporting compliance?
NMFS will not renew or transfer a permit until all reporting requirements for the permit being renewed or transferred have
been met (e.g., logbooks, the MRIP For-Hire telephone survey, etc.). To avoid delays, applicants are encouraged to comply
with all reporting requirements before submitting a permit application.
•

Arrival and departure reports. The operator of each vessel of the United States for which a certificate and permit have
been issued under §300.123 must report by radio to the Port Captain, San Andres Island, voice radio call sign “Capitania
de San Andres,” the vessel's arrival in and departure from treaty waters. Radio reports must be made on 8222.0 kHz or
8276.5 kHz between 8:00 a.m. and 12 noon, local time (1300-1700, Greenwich mean time) Monday through Friday.

•

Catch and effort reports. Each vessel of the United States must report its catch and effort on each trip into treaty waters
to the Science and Research Director on a form available from the Science and Research Director. These forms must
be submitted to the Science and Research Director so as to be received no later than 7 days after the end of each
fishing trip.
1

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, with the application.
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.
Lease Agreement: Include a copy of the current lease agreement if the vessel is leased, rented, or leased-to-own.
The lease must identify the vessel, the individual(s) or business(es) leasing the vessel, and the vessel owners as listed
on the vessel’s USCG Certificate of Documentation or, if not documented, the State Registration. The lease
agreement must include a lease start date, and lease expiration date. The lease must run for a minimum of 7 months
from the date your application is received. The lease may extend for many years if the lessee and lessor anticipate a
long-term arrangement. Both the vessel owner(s) and the lessee(s) must sign and date the lease agreement.
APPLICATION SECTION 1 – Vessel Information
Complete all portions of Section 1.
• 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.

APPLICATION SECTION 2 Vessel intentions
Provide the following information. Attach additional documentation if necessary:
• Principal port of landing for fish to be taken from the Colombian Treaty Waters
• Primary species of fish o be taken from the Colombian Treaty Waters
• Primary gear to be used in to be taken from the Colombian Treaty Waters
APPLICATION SECTION 3 -- Individuals that own the vessel.
If the U.S. Coast Guard Certificate of Documentation or State Registration indicates the vessel is owned by
one or more individuals, complete Section 4 for all owners listed. Complete Section 3a for an individual
owner. Also fill out Section 3b if the vessel is jointly owned by another individual. Photocopy Section 3
as necessary to provide information for all individuals that own the vessel.
• For each owner, provide the owner’s full name, Individual 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). If there is more than one vessel owner and the vessel is not leased, select a
single Primary Mailing Recipient to whom all correspondence about this application and permits will be sent.

•
•
•
•
•
•

APPLICATION SECTION 4 -- Businesses that own the vessel.
If the U.S. Coast Guard Certificate of Documentation or the State Registration is a business, provide
information for all businesses listed. Complete section 4a for a single business owner. Also fill out Section
4b 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, Federal Employer 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).
If there is more than one vessel owner, and the vessel is not leased, select a single Primary Mailing Recipient to
whom all correspondence about this application and requested permits will be sent.
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
2

APPLICATION SECTION 5 – LEASE Information
If the vessel is leased by one or more individuals, fill out section 5A. Copy this section as necessary to
provide information about all individuals that lease the vessel.
• For each individual lessee, include the lessee’s full name, Individual Tax ID number (SSN), date of birth, phone
number, physical address, mailing address, sex, and race/ethnicity information.
• Indicate if the lessee 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).
• If there is more than one vessel lessee, select a single Primary Mailing Recipient to whom all correspondence
about this application and requested permits will be sent.
If the vessel is leased by one or more businesses, fill out section 5B. Copy this page as necessary to
provide information about all businesses that lease the vessel
• For each business that leases the vessel, provide the business’s full name, Federal Employer 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).
• If there is more than one vessel lessee, select a single Primary Mailing Recipient to whom all correspondence
about this application and requested permits will be sent.
• 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
A SPECIAL NOTE ABOUT LEASES: There is no provision in the federal regulations to lease permits. Permit holders may
lease a vessel and obtain permits on the vessel as the lessee. Note that vessel owners and lessees cannot independently
hold permits for the same vessel at the same time.
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 within the ownership
hierarchy of vessel owners or lessees listed in section 4a, 4b, or 5b. 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, Federal Employer 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 4 and Company B in section 6.

3

APPLICATION SECTION 7 –Businesses Officers and Individual Owners
Complete this section for any individual that owns more than 1% of any business within the ownership
hierarchy of vessel owners or lessees, as listed in section 4a, 4b, 5b, or 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, Individual 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).
• If a business listed in Section4a, 4b, 5b, or 6 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% in section 7c.
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 7 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.

APPLICATION SECTION 12 – Small Business or Organization Certification
This section is required for ALL applicants. Your revenue and employment estimates for the most recent complete
calendar year your business or organization was active should include the revenues and employees of ALL affiliated
businesses or organizations. In general, businesses or organizations are affiliated with each other when one
business or organization controls or has the power to control another business or organization, or a third party
controls or has the power to control both. Specifically, businesses or organizations are considered to be affiliated if
they have 50% or more ownership in common. For e.g., if the same individual or individuals own or co-own multiple
businesses, those businesses would be considered affiliated and thus should be treated as a single operation for the
purpose of estimating annual gross revenues and employment.
APPLICATION SECTION 9 – SIGNATURE FOR APPLICATION
If the vessel is leased, a lessee or a lessee’s representative must sign the application as the applicant. If
the vessel is not leased, a vessel owner or an owner’s representative must sign the application as the
applicant.

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 Burden Statement - A Federal agency may not conduct or sponsor, and a person is not required to respond to,
nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements
of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number.
The approved OMB Control Number for this information collection is 0648-0205. Without this approval, we could not
conduct this survey or information collection. Public reporting for this information collection is estimated to be
approximately 50 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to
this information collection are required to obtain benefits. Send comments regarding this burden estimate or any other
aspect of this information collection, including suggestions for reducing this burden to the: PRA Officer, National Marine
Fisheries Service, F/SER26, 263 13th Avenue South, St. Petersburg, FL 33701.
Privacy Act Statement - Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery
Conservation and Management Act (16 U.S.C 1801 et seq.), the High Seas Fishing Compliance Act, the Tuna
Conventions Act of 1950, the Antarctic Marine Living Resources Convention Act, the Western and Central Pacific
4

Privacy Act Statement (continued) Fisheries Convention Implementation Act (16 U.S.C. 6901 et seq.), the Marine
Mammal Protection Act, the Endangered Species Act and the Fur Seal Act. The authority for the mandatory collection of
the Tax Identification Number (TIN) is 31 U.S.C. 7701.
Purpose: In order to manage U.S. fisheries, the National Marine Fisheries Service (NMFS) requires the use of permits
or registrations by participants in the United States. Information on NMFS permit applicants and renewing holders
includes vessel owner contact information, date of birth, TIN and vessel descriptive information. Permit holder
information may be used as sampling frames for surveys, as part of Fishery Management Council (FMC) analysis to
support FMC decisions.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants.
Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within
NMFS offices, in order to coordinate monitoring and management of sustainability of fisheries and protected resources,
as well as with the applicable state or regional marine fisheries commissions and international organizations. Disclosure
of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records
Notice COMMERCE/NOAA-19, Permits and Registrations for the United States Federally Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will
prevent the determination of eligibility for a permit.

5

THIS PAGE INTENTIONALLY LEFT BLANK

OMB No. 0648-0205 Form Approval Expires: 05/31/2020

U.S. Department of Commerce, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13th Avenue South
St. Petersburg, FL 33701
Toll Free 877-376-4877 (9:00 a.m. - 4:00 p.m. ET)
727-824-5326 (9:00 a.m. - 4:00 p.m. ET)
https://www.fisheries.noaa.gov/permits-and-forms

FEDERAL PERMIT/CERTIFICATE
APPLICATION TO FISH IN
COLOMBIAN TREATY WATERS
FOR OFFICE USE ONLY
Reviewer’s Initials and Date
Sanction Case Number IF
Sanctioned
Expiration Date

FOR OFFICE USE ONLY
Application ID

SCAN DATE AND INITIALS

REMEMBER TO SEND A COPY of the current (not expired) United States Coast Guard (USCG) Certificate of Documentation. Do not
send the original.

SECTION 1 - VESSEL INFORMATION
USCG Documentation Number

Year Built

Vessel Name

Name of Company That Built the Vessel

Hull Color

Superstructure Color

Length (ft)

Crew Size-Including the Captain

Total Horsepower

Do you have sails?
YES

ALL APPLICANTS—HOLD or FISH BOX CAPACITY: Estimate
How many pounds of product can you bring to the dock with
a full hold or fish boxes (including ice chests)?

International Radio Call Sign

Hull Material

Hull Identification or IMO Number

Hailing Port City

Hailing Port State

Hailing Port County Or Parish
Gross Tons

NO

Fuel Data

FIBERGLASS

DIESEL

WOOD

GASOLINE

STEEL

OTHER
(DESCRIBE)

Product Storage
(check all that
apply)

ALUMINUM
OTHER
(DESCRIBE)

Net Tons

Fuel Capacity Total Gallons

ON ICE IN
HOLD FISH
BOX, ICE
CHEST,
COOLER,
ETC
FREEZER
LIVE WELL

SECTION 2 - VESSEL INTENTIONS
Principal Port Of Landing Of Fish To Be Taken From Colombian Treaty Waters
Primary Species Of Fish To Be Taken From Colombian Treaty Waters

Primary Gear To Be Used In Colombian Treaty Waters

CTW2020.1P Form Revision 05/11/2020
1

SECTION 3 - INDIVIDUAL VESSEL OWNER(S) INFORMATION
Section 3a: 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 owner of the vessel. Select only ONE mailing recipient.
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 4a
Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

What is this
individual’s Sex?

No

Yes

Male

YES
Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Last Name

Middle Name

NO

Suffix - Jr, Sr, etc.

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Individual Tax ID Number (SSN)

Mailing Address

Date of Birth (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)

City

Apt #

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

Cell Phone number and provider:

Email

Section 3b: Joint Owner. Complete this section if there is more than one individual shown on the USCG documentation, State Registration or
title as the registered joint 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?

MAILING RECIPIENT - All mail about this permit
will go to the individual listed in Section 4b
Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

No

Yes

What is this
individual’s Sex?

Male

YES
Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Middle Name

Last Name

Suffix - Jr, Sr, etc.

If you are operating under a different name,
what is your Doing Business As (DBA) name?

Individual Tax ID Number (SSN)

Mailing Address

Date of Birth (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 belo w.

Email

Cell Phone number and provider:

2

NO

SECTION 4 – BUSINESS VESSEL OWNER(S) INFORMATION
Section 4a: 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.

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

MAILING RECIPIENT - All mail about this permit will go to the business listed in Section 5a
Registered Name of Business

Federal Employer 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 belo w.

Email

Cell Phone number and provider:

Section 4b: 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.
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 business listed in Section 5a
Registered Name of Business

Federal Employer 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 belo w.

Email

Cell Phone number and provider:

3

YES
NO

SECTION 5 –LEASE INFORMATION
If the permit holder is leasing the vessel from the vessel owner in order to assign permits to the vessel, provide the lease information in this section. You must provide a copy of the lease agreement. The term of the lease must be a minimum of 7 months. Please Note: Any permits already
held and assigned to the vessel by the vessel owner will be ended and will not be valid for fishing if the vessel is leased to another permit holder
whose permits are assigned to the vessel.
Lease start date:

Lease end date:

Section 5a: Individual or Joint Lessee: Complete this section if an individual is leasing the vessel from the vessel owner. If more than
one individual is leasing the vessel from the vessel owner. Copy this page as needed to provide information on all lessees.
Is this individual a United States Citizen or
YES
MAILING RECIPIENT - All mail about this permit
NO
permanent resident alien?
will go to the individual listed in Section 6a
Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

No

Yes

What is this
individual’s Sex?

American Indian or Alaska
Native

White
Black or African American

Female

Native Hawaiian or Other Pacific Islander
Other _______________

Asian American

First Name

Last Name

Male

Middle Name

Suffix - Jr, Sr, etc.

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Individual Tax ID Number (SSN)

Date of Birth (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 belo w.

Cell Phone number and provider:

Email

Section 5b: Business Lessee: Complete this section if a business is leasing the vessel from the vessel owner. If a business is leasing the vessel,
officer and owner information for the business must be provided in section 7.
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 business listed in Section 6b
Registered Name of Business

Federal Employer 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 belo w.

Email

Cell Phone number and provider:

4

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 4, 5b. 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

Federal Employer 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 belo w.

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

Federal Enployer 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 belo w.

Email

Cell Phone number and provider:

5

YES
NO

SECTION 7 - BUSINESS OFFICERS AND INDIVIDUAL OWNERS
Complete this section by providing information on all individual officers and owners that own 1% or more of any business listed in sections 4, 5b, 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:

Secretary

Director/ Manager

Shareholder

Other
YES

Is this individual a United States citizen or permanent resident

Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

Treasurer

No

Yes

What is this
individual’s Sex?

Male

Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Last Name

Individual 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 belo w.

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:

Secretary

Director/ Manager

Shareholder

Other
YES

Is this individual a United States citizen or permanent resident

Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

Treasurer

No

Yes

What is this
individual’s Sex?

Male

Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

Individual Tax ID Number (SSN)

Mailing Address

First Name

Middle Name

Date of Birth (MM/DD/YYYY)

Apt #

City

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 belo w.

Email

Cell Phone number and provider:

6

NO

SECTION 8 - SMALL BUSINESS OR ORGANIZATION CERTIFICATION
ALL applicants must complete this section
● For vessels that are leased, complete this section for business(es), including sole proprietorship(s),or organization(s) that
lease the vessel.
● For vessels that are not leased, complete this section for business(es), including sole proprietorship(s), ororganization(s)
that own the vessel (i.e., the business(es), including sole proprietorship(s), or organization(s) that appear on the vessel’s
USCG documentation or state registration).
Information needed to complete this section: Please estimate your annual gross revenues (sales) for the most recent calendar
year your business or organization was active prior to this year. Your primary activity is the activity that generated the greatest
percentage of annual gross revenues in the most recent complete calendar year the business or organization was active. Review
the business/organization descriptions in Boxes 1 through 7 and identify the one that describes the applicant’s primary activity. If
the business is primarily a seafood dealer or processor, estimate the number of employees for the most recent calendar year your
business or organization was active prior to this year. Include all full-time, part-time, and temporary employees in your estimate,
but do not include crew that work on any vessels owned by the business or organization or its affiliates. Your estimates should account for the revenues and employees of ALL businesses and organizations with which your business or organization is affiliated.
See the instructions at the beginning of the application package for more information about affiliation. If you have questions about
affiliation and how it applies in your case, please call 727-824-5305 and ask for one of our Office’s economists.
How to fill out the form: Start with Box 1. If the answer to the question in Box 1 is “Yes,’’ check “Yes” and answer the questions in
the box to the right and follow the instructions in that box. If the answer to Question 1 is “No,” check “No” and go to Box 2. Continue this process until you have either: (1) answered “Yes” to ONE of the questions in Boxes 1 through 6 AND the applicable questions in the boxes to the right, OR (2) answered all questions in Box 7.
Box 1. Is the business primarily involved in
harvesting seafood (commercial fishing)?

1A) Was the business active prior to
this year?

Yes

Yes

No

No

If the answer is yes, go to question 1A to the
right. Otherwise, go to Question 2 below.

If yes, go to question 1B. If no, you
are done. Go to Section 9 of the
application.

Box 2. Is the business primarily involved in
for-hire fishing services (charter, party/
headboat)?

2A) Was the business active prior to
this year?

Yes

No

If the answer is yes, go to question 2A to the
right. Otherwise, go to Question 3 below.

Box 3. Is the business primarily involved in
buying and selling seafood (seafood
dealer/wholesaler)?
Yes

No

Yes

No

If yes, go to question 2B. If no, you
are done. Go to Section 9 of the
application.

3A) Was the business active prior to
this year?
Yes

No

If the answer is yes, go to question 3A to the
right. Otherwise, go to Question 4 below.

If yes, go to question 3B. If no, you
are done. Go to Section 9 of the
application.

Box 4. Is the business primarily involved in
processing seafood (seafood processor)?

4A) Was the business active prior to
this year?

Yes

Yes

No

If the answer is yes, go to question 1A to the
right. Otherwise, go to Question 5 on the next
page.

No

If yes, go to question 4B. If no, you
are done. Go to Section 9 of the
application.

Next page
7

1B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than $11 million in
gross receipts in that year? Yes
No
You are done. Go to Section 9 of the
application.

2B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than $8 million in
gross receipts in that year? Yes
No
You are done. Go to Section 9 of the
application.

3B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than 100
employees? Yes
No
You are done. Go to Section 9 of the
application.

4B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than 750
employees? Yes
No
You are done. Go to Section 9 of the
application.

SECTION 8 - SMALL BUSINESS OR ORGANIZATION CERTIFICATION
(Continued from previous page)

Box 5. Is the organization an Environmental,
Conservation and Wildlife, or Professional
Non-Profit Organization?

Yes

No

Box 5. Is the organization some other NonProfit Organization (e.g., business association)?

Yes

No

5A) Was the organization active
prior to this year?
Yes

organization was active prior to this year?
_____________

No

Did the organization have more than $15

If yes, go to question 5B.

Million in gross receipts?

If no, STOP! You are done.

STOP! You are done.

6A) Was the organization active
prior to this year?

6B) What was the most recent year the

Yes

If the answer is yes, go to question 6A to the
right. Otherwise, go to Question 7 below.

5B) What was the most recent year the

No

Yes

No

business was active prior to this year?

_____________
Did the organization have more than $7.5

If yes, go to question 6B.

Million in gross receipts? Yes

If no, STOP! You are done.

STOP! You are done.

No

7) The business or organization must be primarily involved in another industry not related to fishing or seafood.
Refer to SBA’s list of North American Industry Classification System (NAICS) codes
(see https://www.sba.gov/document/support--table-size-standards ) and enter the NAICS code for your primary activity here:

Based on the applicable SBA size standard, check the appropriate box to indicate if the business or organization is Large or Small and
report the year on which that conclusion was based.

Large

Small

Year:

STOP! You are done.

SECTION 9 - SIGNATURE

The undersigned certifies under penalty of perjury that the foregoing information is true and correct (28 USC 1746; 18 USC 1621; 18 USC
1001, 16 USC 1857). If the vessel listed in Section 1 is leased, the applicant who signs below must be an individual named as

a lessee in Section 5a, or an officer or shareholder of the lessee as listed in Section 5b, with that individual’s information
listed in section 7. If the vessel listed in Section 1 is not leased, the applicant must be an individual named as an owner in
Section 4, or an officer or shareholder of the owner as listed in Section 7.

Applicant’s Signature

Date

Print Name

Position in Business

8