Form 3-200-23 Application - Export of Pre-Convention, Pre-Act, or Anti

FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Export or Re-Export of Pre-Convention, Pre-Act, or Antique Specimens (CITES/MMPA/ESA)
☐New ☐Reissue/Renew ☐Amendment
APPLICATION FORM INSTRUCTIONS
The following instructions pertain to U.S. Fish and Wildlife Service (FWS) permit applications. The General Permit Procedures in 50
CFR 13 address the permitting process. For simplicity, all licenses, permits, registrations, and certificates are referred to as a permit.
If you are an individual, who would be named on the face of the permit, you need to complete the Individual Applicant section of this
application.
If you are an individual seeking permits issued to yourself for activities not associated with your business or institution, you need to
complete the Individual Applicant section as an individual permittee.
If you are an individual associated with a business or institution, and the business or institution’s name would appear on the face of the
permit, you need to complete the Business Applicant section of this application.
If you are a business applying on behalf of an individual, you need to complete the Business Applicant section of this application and
include a limited power of attorney from the person for whom you represent.
A person/entity is qualified to obtain a U.S. Fish and Wildlife Service permit or license when they are "subject to the jurisdiction of the
United States", per 16 USC 1532(13). A foreign person/entity with no permanent physical presence in the United States only qualifies
for an import/export license when they physically enter or exit the U.S. with the wildlife items. The foreign entity is required to designate
a U.S. agent for purposes of record keeping.
GENERAL INSTRUCTIONS:
•

An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are filling in the
appropriate application form for the proposed activity. Items marked with an asterisk (*) are required fields.

•

Print clearly or type in the information. Illegible applications may cause delays.

•

Sign the application. Faxes or copies of the original signature will not be accepted.

•

If you choose to mail your submission, mail the original application to the address listed below or, if applicable, on the attached
address list. We encourage electronic filing in the ePermits system.

•

Keep a copy of your completed application.

•

Please plan ahead. Unless otherwise indicated, allow at least 60 days for your application to be processed, however, some
applications may take longer than 90 days to process (50 CFR 13.11). Longer processing times will be noted on those applications.

•

Applications are processed in the order they are received.

Individual or Business Applicants:
Individual Applicant. Complete if applying as an individual [do not complete this application if applying for Import/Export License (3200-3) or a Designated Port Exception Permit (3-200-2)]:
•

Enter the information requested. Required fields must be completed. This is used to create your profile and consumer information
in the ePermits system. If you do not have an email address, enter not applicable.

•

Doing business as (dba) / Affiliation: The Division of Management Authority (DMA) and the Office of Law Enforcement (OLE) do
not accept doing business as affiliations for individuals seeking permits on behalf of themselves. “Doing business as” affiliations
apply to individuals seeking permits for a business, agency, Tribe, organizational, or institutional affiliation directly related to the
activity requested in the application. For example, a taxidermist is an individual whose business can directly relate to the requested
activity of exporting taxidermy (dba relevant permit); however, said taxidermist should not apply as a business for permits to nonbusiness related travel with their pet exotic parrot (dba is not relevant to the permit; complete the Business Applicant section).

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Business Applicant. Complete if applying as a business, corporation, public agency, Tribe, or institution:
•

Enter the information requested. Required fields must be completed. This is used to create your contact and account information in
the ePermits system. If you do not have an email address, enter not applicable.

•

If you are applying on behalf of a client, a document evidencing power of attorney must be included with the application.

•

Principal Officer is the person in charge of the listed business, corporation, public agency, Tribe, or institution. The principal
officer is the person responsible for the application and any permitted activities. Often the principal officer is a Director or President.

•

The Contact is the person at the business, corporation, public agency, or institution who will be available to answer questions
about the application or permitted activities. Often this is the preparer of the application. Each person that is associated with the
business that would need to access the business account needs to create their own contact in the ePermits system.

Application processing fee:
•

•

An application processing fee is required at the time of application, unless exempted under 50 CFR 13. The application processing
fee is assessed to partially cover the cost of processing a request. The fee does not guarantee the issuance of a permit, nor
will fees be refunded for applications for which processing has begun. Checks or money orders must be for the exact
amount for each application submitted. If you are making more than one request, you must submit a separate payment
for each request, otherwise your application will be returned.
Documentation of fee exempt status is not required for applications submitted by Federal, Tribal, State, or local
government agencies; but must be supplied by those applicants acting on behalf of such agencies. Such applications
must include a letter on agency letterhead and signed by the head of the unit of government for which the applicant is acting on
behalf, confirming that the applicant will be carrying out the permitted activity for the agency.

CERTIFICATION:
•

The individual identified in the Individual Applicant Section, the principal officer named in the Business Applicant Section, or person
with a valid power of attorney (documentation must be included in the application) must sign and date the application. This
signature legally binds the applicant to the statement of certification. You are certifying that you have read and understand the
regulations that apply to the permit. You are also certifying that all information included in the application is true to the best of your
knowledge. Be sure to read the statement and re-read the application and your answers before signing.

ALL APPLICANTS COMPLETE THE QUESTIONS ASSOCIATED WITH YOUR APPLICATION
Please continue to next page. DO NOT RETURN THIS PAGE WITH THE APPLICATION
Mail applications to: U.S. Fish and Wildlife Service; Division of Management Authority; Branch of Permits, MS:IA; 5275 Leesburg
Pike; Falls Church, Virginia 22041-3803 or as directed by specific applications.
If you would like expedited mailing, 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.
Please refer to the fee schedule for the appropriate fees for the activity you are requesting.

If you are making more than one request, you must submit a separate payment
for each request, otherwise your application will be returned.

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

INDIVIDUAL APPLICANTS
*First Name

Middle Name

*Last Name

*Email Address

Telephone Number

*Street Address

*City

*State/Province

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, 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.

Have you or your client (if a broker applying on behalf of your client), 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”, 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.

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Certification Statement
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.

Signature and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
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))
*Required fields. Applications without this information are subject to delays or returns.

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

BUSINESS APPLICANTS
*Business Name

doing business as (dba)

*Indicate your business type:
__ Business or other for profit
__ Farm

__ Small business

__ Government (Federal/State/Local/Tribal)

__ Not-for-profit institution

Name that will appear on the permit if you are applying on behalf of an individual/business

*Primary Contact Name

*Primary Contact Email Address

*Business Email Address

*Preferred Contact Method (e.g. phone, email)

*Principal Officer Name

*Principal Officer Title

*Principal Officer Email

Tax ID Number

*Business Phone

Alternate Phone

*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you wish to have your permit mailed to a different address, complete the following:
*Street Address

*State/Province

*City

*Zip or Postal Code

*Country

If you would like expedited mailing, 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.

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

Have you or your client (if a broker applying on behalf of your client), 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”, 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.

Certification Statement
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.

Signature and date

Include a check or money order, payable to the U.S. FISH AND WILDLIFE SERVICE, as
a nonrefundable processing fee [50 CFR 13.11(d)(4)] (see instructions above).
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))
*Required fields. Applications without this information are subject to delays or returns.

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

EXPORT OR RE-EXPORT OF PRE-CONVENTION, PRE-ACT, OR ANTIQUE SPECIMENS
(CITES/MMPA/ESA)
Description
pre-Convention
(CITES)
pre-Act
(ESA)

Antique
(ESA)

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.
Specimen was held in a controlled environment on or before (a) December 28, 1973 or
the date 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.
Specimen is not less than 100 years old, has not been repaired or modified on or after
December 28, 1973 with any part of any species protected by ESA and a) has entered at
a port 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.
Specimen was taken prior to December 21, 1972.
1

pre-MMPA

CITES - Convention on International Trade in Endangered Species of Wild Fauna and Flora
ESA – Endangered Species Act
MMPA – Marine Mammal Protection Act
Provide the following information. Complete all questions on the application. Mark questions that are not
applicable with "N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you
submit, indicate the application question number you are addressing.
Note 1: For shipment of Brazilian rosewood (Dalbergia nigra), submit form 3-200-32.
Note 2: Finished products of some timber species, such as big leaf mahogany, are not covered under CITES
(only logs, sawn timber, and veneer), while other finished products of species require CITES documents.
If you want to export furniture or other finished products containing CITES-listed wood, please contact the
Division of Management Authority or visit the CITES page at www.cites.org to determine if a CITES
document is required.
Note 3: For the export of Pre-Convention, Pre-Act, or antique musical instruments/traveling orchestras 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 State), submit application 3-200-88.
Note 4: For fossilized walrus ivory removed from the wild after 1972, please use form 3-200-27.
Note 5: African elephant ivory: Raw ivory cannot be re-exported. Worked ivory that qualifies as an antique may
be exported. For non-commercial exports, antique worked ivory may also be exported. In addition, worked
ivory that was removed from the wild before February 4, 1976, and is part of either a household move or
an inheritance could qualify to be exported. (For export of worked African elephant ivory that is contained
in a musical instrument and traveling orchestras, please use form 3-200-88; for worked African elephant
ivory that is part of a traveling exhibition, please use form 3-200-30). Please review our webpage “What
Can I Do With My Ivory?” for important guidance and reminders.

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 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

This application is for (choose all that apply):

☐ A new permit
☐ Renewal of permit # ____________________________
☐ Amendment of permit # __________________________
1. For EACH specimen being exported/re-exported, please provide the following: (You may submit as a
separate document, as long as the information is provided as outlined in the table.)
Scientific name (genus,
species, and, if
applicable, subspecies)

Common
Name

Qty

Description of Item (e.g.,
published description from a
catalog or art book)

Size (include
unit of
measurement)

Date of
Manufacture

Date of acquisition
(e.g., bill of sale, U.S.
Customs import
declaration,
transferred document)

2. Type of Activity:

☐ Export
☐ Re-export (e.g., exporting a specimen that was previously imported into the United States)

3.

What is the purpose of the export?

☐ Commercial ☐ Personal ☐ Scientific ☐ Exhibition
☐ Other (specify)

4. Provide the current location of specimen(s) (address and country)
Name:
Address:
City:
State/Province:
County, Postal Code:
5. Name and address of foreign recipient
Name:
Address:
City:
State/Province:
County, Postal Code:
6. If protected under CITES, provide documents, signed statement, or other evidence that the specimen(s)
was obtained or manufactured prior to the date CITES applied to the item (see pre-Convention definition
above).

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OMB Control No. 1018-0093
Expires xx/xx/xxxx

FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

7. For specimens(s) protected under the U.S. Endangered Species Act (ESA), provide one of the following:
a. For Antiques (see definition above):
i. Provide documentation which shows the age of the item OR a statement from a qualified appraiser
attesting to the age;
ii. 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, AND
iii. Documentation showing that the specimen either was imported through a designated antiques port or
was in the United States before September 22, 1982 (the date the antiques ports were established).
b. For the non-commercial export of worked African elephant ivory that is part of a household
move or inheritance and is not an antique, please provide the following:
i. Documentation that shows that the ivory used in the specimen was removed from the wild before
February 4, 1976 (this may consist of a statement from a qualified appraiser or family
documentation), and
ii. If the export is part of a household move, documentation on when the specimen was acquired and
how long the specimen has been in your possession OR
iii. If the export is part of an inheritance, documentation on the inheritance, such as a will or legal
documents.
c. 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, you must complete form 3-200-37d.
☐ No, sign the following certification:

CERTIFICATION STATEMENT original signature is required
I certify to the best of my knowledge and belief that each of the items identified in Question 1 AND Question 7.c.
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 (if you have questions about this certification statement, please contact the
Division of Management Authority).
Applicant's signature:

Date:

8. 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 sea lions; not walrus) specimens, provide either a copy of NOAA Fisheries
letter of authorization or evidence that NOAA Fisheries has been contacted.
9. If Re-export provide:
a.
b.

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
Cleared FWS Wildlife Declaration for Import (Form 3-177) (applies to animal specimens only).

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

10. Is this shipment a sample collection being exported for temporary exhibition or display purposes
and accompanied by a valid ATA carnet?

☐ No

☐ Yes, provide ATA carnet document number: _________________________________

Be aware that there may be additional permitting or approval requirements by your local or state
government, as well as required by other Federal agencies or foreign government to conduct your
proposed activity. While the FWS will attempt to assist you, it is your responsibility to obtain such
approval.
All international shipment(s) must be through a designated port. A list of designated ports (where a wildlife
inspector is posted) is available. If you wish to use a port not listed, please contact the Office of Law Enforcement
for a Designated Port Exemption Permit (Form 3-200-2).

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FWS Form 3-200-23 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
Expires xx/xx/xxxx

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 (PRA; 44 U.S.C. 3501 et seq.) 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 PRA, 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 36 minutes (electronically) to 45 minutes
(paper-based), 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 (JAO/3W),
Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this
address.
Questions regarding permits from Management Authority should be sent to [email protected].

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