Form 3-200-64 Application - Certificate of Ownership for Personally Ow

FWS Form 3-200-64 (Rev. 01/2020)
U.S. Department of the Interior

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

CERTIFICATE OF OWNERSHIP FOR PERSONALLY OWNED WILDLIFE "PET PASSPORT"
(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 3-200-64 (Rev. 01/2020)
U.S. Department of the Interior

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

E. CERTIFICATE OF OWNERSHIP FOR PERSONALLY OWNED WILDLIFE "Pet passport" (CITES)
Note: This form is used to request a passport-like certificate for a single animal (one pet per application).
• Your primary residence must be in the United States (i.e., residing the majority of the year in the United
States) to be eligible for this certificate.
• Certificates cannot be re-issued if the pet is currently outside the United States; therefore the pet must
return to the United States prior to the expiration of the certificate.
• Certificates issued are typically valid for three years, and are intended for multiple border crossings.
• Please review our webpage “Personal Pets” for important guidance and reminders.
• Per USDA requirement, birds may not enter the U.S. at a land border port from Mexico.
If you are interested in obtaining a single permit for multiple animals without needing multiple crossings, or are
intending to move your pet overseas permanently, please use form 3-200-46 .
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. A separate application and certificate is needed for each animal.
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 the U.S. Postal Service.

2. Who should we contact if we have questions about the application (name, phone number, and e-mail)?

3. Have you, 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, or convicted, or entry of 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? Or have you forfeited collateral, or are currently under charges for any violations of
the laws mentioned about?
No

Yes

If you answered “Yes” to Question 2, 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” answer
does not automatically disqualify you from getting a permit.

4. This is a for Re-issuance use application 3-200-52 :
New Application
Amendment of Permit#

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FWS Form 3-200-64 (Rev. 01/2020)
U.S. Department of the Interior

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

5. Provide the following information (note: In most cases, your animal must be permanently marked to
qualify for a Certificate of Ownership):
Scientific name (genus,
species, and, if applicable,
subspecies)

Common Name

Birth/Hatch date
mm/dd/yyyy

Sex

Permanent
marking 1 and/or
name

Household
name

Source
(wild/
captive-born)

6. What is the current location of your pet?

7. Will you be traveling on holiday (vacation) or relocating with your pet?
8. Indicate date of travel and country or countries of destination (if currently known):

ORIGIN OF YOUR PET: On a separate sheet of paper, answer question 8 if your pet was wild-caught; question 9
if your pet was captive-born; and question 10 if you do not know the origin of your pet.
9. For animals that were wild caught:
a. If your pet was removed from the wild within the United States, provide:
i.

Evidence that it was legally acquired (State authorization);

ii.

The purpose for which the animal was removed from the wild; and

iii.

The date the animal was removed from the wild.

iv.

Documentation demonstrating the history of transactions (e.g., chain of ownership(s) of
animal).

b. If your pet was removed from the wild outside the United States, provide:
i.

Country of origin;

ii.

Evidence that it was legally imported into the U.S. (please refer to question 10); and

iii.

The date you acquired the animal.

iv.

Documentation demonstrating the history of transactions (e.g., chain of ownership(s) of
animal).

10. For animals that were captive-born:
Provide a dated and signed statement from the breeder that includes the following:
1

(e.g., tattoo number; band number; microchip number, type, and location on animal; prominent scars. Some pets, such as snakes,
may not be suitable for permanent marking such as microchips or tattoo. Prominent coloration or markings that distinguish the animal
from others of it species may be sufficient.)

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FWS Form 3-200-64 (Rev. 01/2020)
U.S. Department of the Interior

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

i.

Scientific and common names of bird;

ii.

Hatch date, band/tag number or identifying markings, and sex of the animal;

iii.

Name and address of the facility where the animal was bred and born;

iv.

Location of parental stock; and

v.

A statement that the animal was bred at the above facility.

vi.

In addition, provide documentation demonstrating the history of transactions (e.g., chain or
ownership of pet(s)).

11. If you do not know the origin of your pet, provide a signed and dated statement with a complete description of
the circumstances under which you acquired the pet, including when, where, from whom, and any other pertinent
information. Include pet store receipts or other information that would assist in determining the source of your pet.
12. For animals previously imported into the United States (i.e., did not originate from the United States),
provide evidence that the animal was legally imported, including:
a.

Copies of validated canceled CITES export permits or re-export certificates issued by the
appropriate CITES office in the country from which the wildlife was imported, and a copy of the
cleared Declaration for Importation (form 3-177).

b.

If you did not make the original import, provide copies of the importer’s documents outlined above
and any invoice or other documents that show you purchased or otherwise obtained the wildlife
from the original importer.

c.

If you did not obtain the wildlife from the original importer, include documentation demonstrating the
history of transactions.

d.

For exotic birds previously imported, provide a copy of the Wild Bird Conservation Act (WBCA)
import authorization.

13. If requesting a passport for a species listed on the Migratory Bird Treaty Act (listed in 50 CFR 10.13),
provide Federal and/or State permit(s) or license numbers that authorize possession and acquisition
14. Transport conditions must comply with the CITES Guidelines for Transport of Live Animals or, in the case
of air transport, with the International Air Transport Association (IATA) live animal regulations (contact
airlines for additional information). Please provide a description of the shipping conditions including:
a.

The type, size, and construction of any shipping container; and

b.

The arrangements for watering or otherwise caring for your pet during transport.

15. When travelling with your pet, there may be animal health requirements specific for that destination. As
soon as you know your travel details, contact your local veterinarian to assist with the pet travel process.
Factors to consider may include meeting time frames for obtaining a health certificate, updating
vaccinations, diagnostic testing, or administration of medications/ treatments. Please contact Dept. of
Agriculture Animal and Plant Health Inspection Service .
16. Be aware that certain States require pet possession certificates. Contact your State conservation agency
for pertinent requirements, and submit copies of applicable documentation with your application.
17. I expect the [export/re-export/import] to occur at the following U.S. port(s):_____________________
18. All international shipment(s) of wildlife must be declared to the U.S. Fish and Wildlife Service at the
time of export/import. A list of designated ports (where a wildlife inspector is posted) is available.
If you wish to use a port not listed, additional authorization to use a non-designated port will be
required. If you wish to use several different non-designated ports, you may be required to contact
the Office of Law Enforcement for additional authorization.
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FWS Form 3-200-64 (Rev. 11/2019)
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 20 minutes (electronically) to 30 minutes (paperbased), including 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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