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

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

FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

Export of Pre-Convention, Pre-Act, or Antique Musical Instrument/Traveling Exhibition Certificate
(CITES and/or ESA, MMPA)
☐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 3-200-88 (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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OMB Control No. 1018-0093
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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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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OMB Control No. 1018-0093
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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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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OMB Control No. 1018-0093
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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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

FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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

EXPORT OF PRE-CONVENTION, PRE-ACT, OR ANTIQUE MUSICAL INSTRUMENT/TRAVELING
EXHIBITION CERTIFICATE (CITES and/or ESA, MMPA)
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 (ESA)
Specimen was held in a controlled environment on or before (a) December 28, 1973, or the date
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 (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 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
ESA – Endangered Species Act
MMPA – Marine Mammal Protection Act
NOTE 1: This form is used to request a passport-like certificate for musical instruments. The applicant’s physical
address 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 (Res. Conf. 16.8 (Rev CoP17)) (e.g., the instrument is not being
offered for sale or being sold while outside the United States).
NOTE 2: Certificates may be issued to individuals or to ensembles. If you wish to obtain the ensemble certificate,
please use the Ensemble Inventory table (or create your own based on this framework) located on page 10 of this
application form.
Please refer to the following links for additional information and guidance: “What Can I Do With My Ivory?”. For
further questions, please contact us at [email protected].
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 3: African elephant ivory removed from the wild after February 4, 1977, is not considered to be PreConvention; worked African elephant ivory may only be re-exported for non-commercial purposes (e.g., you
cannot sell the ivory once exported).
1. For EACH musical instrument, please provide the following (for your convenience, an Ensemble Inventory table has
been provided on page 10 for ensembles with multiple musical instruments):
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 and photo 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;
e. Date of importation.

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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OMB Control No. 1018-0093
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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

2. This application can be used to request:

☐ A new musical instrument certificate for an individual
☐ A new traveling exhibition certificate for musical ensembles
☐ Renewal and/or Amendment of a current Certificate, # __________________
3. What is the purpose of the export?

☐ Personal
☐ Display

☐ Performance
☐ Competition

☐ Other (specify) ____________________

4. Provide documentation or other information on how the instrument was acquired (e.g., bill of sale, U.S. Customs
import declaration, transfer documents).
5. If the instrument was imported into the United States after the species’ CITES-listing date, provide:
a. 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
b. Cleared Wildlife Declaration for Import form 3-177 (hard copy or electronic release) if the instrument contains
wildlife species; or
c. Cleared import documentation from USDA-APHIS or Customs and Border Protection (CBP) if the instrument
contains plant species.
6. Provide the current location of specimen(s) (address and country):
Name:
Address:
City, State/Province:
County, Postal Code:
7. 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.

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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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

U.S. Endangered Species Act (ESA) Section
8. For Antiques (see definition above), provide:
a. Documentation which shows the age OR a statement from a qualified appraiser attesting to the age; AND
b. A 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 the ESA.
9. 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:
a. Has this item entered into commerce (e.g., bought, sold, or offered for sale by you or anyone else) since
December 28, 1973?

☐ Yes, there may be a need for additional information—the Division of Management Authority will contact you
directly.

☐ No, sign the following certification statement:
CERTIFICATION STATEMENT:
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 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 sea lions; not walrus) specimens, provide either a copy of the NOAA Fisheries letter
of authorization or evidence that NOAA Fisheries has been contacted.
Please note that you may need to obtain additional authorizations required under State, Tribal, Federal, or foreign
government(s) for the activities that you want to conduct. While the FWS 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 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).
If you indicate which U.S. port(s) you will be traveling through, the FWS will assist you in contacting the appropriate border
officials.

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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

OMB Control No. 1018-0093
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Table 1: Ensemble Inventory Table
Ensemble Inventory
Item
#

Last Name of
Musician

Type of Item

0

Frazer

Violin bow tip

Date
Made

Country of
Origin

Date Item
Acquired

ca. 1875

France

5/25/2015

Date Item
Imported

Does item contain the following? Check all that apply
African
Elephant
(Loxodonta
africana)
X

Tortoiseshell
(Eretmochelys
imbricata)

Brazilian
rosewood
(Dalbergia
nigra)

Lizard skin
(Varanus
salvator)

Other
wildlife
species?
(specify)

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OMB Control No. 1018-0093
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FWS Form 3-200-88 (Rev. 02/2023)
U.S. Department of the Interior

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 to average:
Original submission - paper-based: 1 hour for individuals and 1.5 hours for private sector and government
Original submission - electronically: 45 minutes for individuals and 1.25 hours for private sector and government
Amended submission - paper-based: 1 hour for individuals and 1.5 hours for private sector and government
Amended submission - electronically: 45 minutes for individuals and 1.25 hours for private sector and government
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 (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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