Request to Transfer Gulf Aquaculture Permit

OMB Control No. 0648-XXXX

Expiration Date:

REQUEST TO TRANSFER GULF AQUACULTURE PERMIT

This form must be received by NMFS

at least 30 days prior to the date which the transferee desires to have the transfer effective.

A Gulf Aquaculture permit is transferable to an eligible person (i.e., a U.S. citizen or permanent resident alien). Permits may be transferred only if the geographic location of the aquaculture site remains unchanged.

For questions, contact the Regional Aquaculture Coordinator at (727) XXX-XXXX or email XXXXXXX@noaa.gov.

FOR OFFICE USE ONLY
Date Received
Gulf Aquaculture Permit Number
Permit Expiration Date
Violation Date
Violation Clear Date
Reviewer Initials and Date

1. TRANSFEROR INFORMATION (ORIGINAL PERMIT HOLDER)

GULF AQUACULTURE PERMIT NUMBER EXP. DATE (MM/DD/YYYY) NAME OF TRANSFEROR

/ /

MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

WORK TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS

2. TRANSFEREE INFORMATION (NEW PERMIT HOLDER)

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

HOME TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS

/ /

DATE OF BIRTH (MM/DD/YYYY) SOCIAL SECURITY NUMBER or PERMANENT RESIDENT ALIEN ID

3. TRANSFEREE BUSINESS INFORMATION

(A) Provide business information for the transferee, if applicable.

BUSINESS NAME MAILING ADDRESS

CITY STATE COUNTY ZIP CODE

/ /

BUSINESS TELEPHONE NUMBER DATE WHEN BUSINESS FORMED (MM/DD/YYYY) STATE WHERE FORMED

(B) Provide information on the names, addresses, and titles of all officers, partners, and directors, if applicable.

OFFICER/PARTNER/DIRECTOR #1

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

POSITION IN COMPANY MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

HOME TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS

DATE OF BIRTH (MM/DD/YYYY) SOCIAL SECURITY NUMBER or PERMANENT RESIDENT ALIEN ID

/ /

OFFICER/PARTNER/DIRECTOR #2

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

POSITION IN COMPANY MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

HOME TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS

/ /

DATE OF BIRTH (MM/DD/YYYY) SOCIAL SECURITY NUMBER or PERMANENT RESIDENT ALIEN ID

(C) Has the transferee or corporation, or any shareholder, director, partner, or officer applied for a Gulf Aquaculture permit in the past?

Yes No

If Yes, provide name and business affiliation of person(s) who have applied for a permit in the past as well as the date the application was submitted to NMFS.

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

/ /

BUSINESS NAME DATE APPLICATION SUBMITTED (MM/DD/YYYY)

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

/ /

BUSINESS NAME DATE APPLICATION SUBMITTED (MM/DD/YYYY)

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

/ /

BUSINESS NAME DATE APPLICATION SUBMITTED (MM/DD/YYYY)

(D) Provide information for all shareholders who own or control at least 10% of the outstanding stock and the percentage of outstanding stock currently owned or controlled by each such shareholder.

Name (First, Last, Middle) Street Address City, State, Zip Percentage of Stock Owned

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

7. ________________________________________________________________________

8. ________________________________________________________________________

9. ________________________________________________________________________

10. ________________________________________________________________________

(E) Does the transferee or any shareholder, director, partner, or officer own an interest, either directly or beneficially, in any other Gulf Offshore Aquaculture venture?

Yes No N/A

If Yes, provide the name of the person, Gulf Aquaculture permit number and relationship to the venture.

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

GULF AQUACULTURE PERMIT NUMBER RELATIONSHIP TO VENTURE

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

GULF AQUACULTURE PERMIT NUMBER RELATIONSHIP TO VENTURE

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

GULF AQUACULTURE PERMIT NUMBER RELATIONSHIP TO VENTURE

(F) Has the transferee or any shareholder, director, partner, or officer listed in part D above ever been arrested, indicted, convicted of, or adjudicated to be responsible for any violation of marine resources or environmental protection law, whether state or federal?

Yes No

If Yes, please provide the name of the person(s) involved and the date of the violation.

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

/ /

DATE OF VIOLATION (MM/DD/YYYY) TYPE OF VIOLATION

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.)

/ /

DATE OF VIOLATION (MM/DD/YYYY) TYPE OF VIOLATION

4. TRANSFEREE VESSEL AND AIRCRAFT DOCUMENTATION

Provide all information for each vessel to be used for transport, harvest, transfer, or sale of cultured species at the approved site. Attach a copy of the valid, unexpired USCG Certificate of documentation (or valid state registration if not documented) for each vessel listed. Also provide documentation or identification numbers for any aircraft or vehicles involved.

VESSEL #1

USCG DOC. NUMBER (STATE REG IF NOT DOCUMENTED) VESSEL NAME LENGTH TOT.HORSEPOWER

HOMEPORT CITY AND STATE PORT OF LANDING CITY AND STATE HOLD CAP. (TONS) LIVE WELL CAP. (GALLONS)

VESSEL #1 OWNER INFORMATION CHECK ONE: INDIVIDUAL BUSINESS

NAME (FIRST, MIDDLE, LAST, SUFFIX or BUSINESS) HOME or BUSINESS TELEPHONE NUMBER

MAILING ADDRESS CITY STATE ZIP CODE

SOCIAL SEC. or PERMANENT RESIDENT ALIEN ID DATE OF BIRTH (MM/DD/YYYY) FEDERAL ID # (FEIN) if a BUSINESS

VESSEL #2

USCG DOC. NUMBER (STATE REG IF NOT DOCUMENTED) VESSEL NAME LENGTH TOT.HORSEPOWER

HOMEPORT CITY AND STATE PORT OF LANDING CITY AND STATE HOLD CAP. (TONS) LIVE WELL CAP. (GALLONS)

VESSEL #2 OWNER INFORMATION CHECK ONE: INDIVIDUAL BUSINESS

NAME (FIRST, MIDDLE, LAST, SUFFIX or BUSINESS) HOME or BUSINESS TELEPHONE NUMBER

MAILING ADDRESS CITY STATE ZIP CODE

SOCIAL SEC. or PERMANENT RESIDENT ALIEN ID DATE OF BIRTH (MM/DD/YYYY) FEDERAL ID # (FEIN) if a BUSINESS

5. ADDITIONAL INFORMATION

The following information must be submitted with the request for transfer:

1. The original Gulf Aquaculture permit. The transferor must sign the back of the permit and have the signed transfer document notarized.

2. Copy of the signed bill of sale or equivalent acquisition papers.

3. Copy of a notarized written agreement signed and dated by the transferor and transferee which specifies who is assuming the responsibilities and liabilities associated with the Gulf Aquaculture permit and the aquaculture facility, including all the terms and conditions associated with the original issuance of the Gulf Aquaculture permit.

6. PERMIT CONDITIONS

1. An annual fee of $1,000.00 must be received by NMFS by January 31 of each year for permits to remain active. Fees may change slightly each year.

2. All applicable permit requirements and conditions must be satisfied prior to a permit transfer, including any necessary updates, e.g., updates regarding required certifications, legal responsibility for assurance bond, other required permits, etc.

3. Final transfer of a Gulf Aquaculture permit will occur only after NMFS provides official notice to both parties that the transferee is eligible to receive the permit and that the transfer is otherwise valid.

4. A Gulf Aquaculture permit that is altered, erased, or mutilated is invalid. A replacement Gulf Aquaculture permit may be issued. An application for a replacement permit is not considered a new application.

5. The Gulf Aquaculture permit must be prominently displayed and available at the aquaculture facility. In addition, the aquaculture facility’s permit (if the fish have not yet been purchased by a dealer), must accompany each vehicle that is used to receive fish harvested from an aquaculture facility in the Gulf EEZ. A vehicle operator must present the permit or a copy for inspection upon the request of an authorized officer.

6. An aquaculture facility owner who has been issued a permit must notify the Regional Aquaculture Coordinator within 30 days after any change in the application information specified in 50 CFR 622.101(d)(11). The permit is void if any change in the information is not reported within 30 days.

7. The transferee must comply with all other operational, monitoring, recordkeeping, and reporting requirements as outlined in subpart F of 50 CFR part 622. Forms and associated guidance for these requirements can be found at: (website to be determined).

8. A Gulf Aquaculture permit may be revoked, suspended, or modified, and such permit applications may be denied, in accordance with the procedures governing enforcement-related permit sanctions and denials found at subpart D of 15 CFR part 904.

7. TRANSFEREE CERTIFICATION

I certify that all broodstock used under auspices of this permit will originate from U.S. waters of the Gulf of Mexico and/or will originate from the same population or sub-population of fish where the aquaculture facility is located or progeny of such wild broodstock, and that broodstock will be individually marked or tagged at the hatchery to allow for identification of those individuals used in spawning.

Further, I certify that no transgenic or genetically modified organisms (GMOs) will be used or possessed in the aquaculture facility and no transgenic or GMOs will be used in the production of the juveniles or associated broodstock. I also certify that fin clips or other genetic information will be collected and submitted for each individual broodstock animal (in accordance with procedures specified by NMFS) at least 30 days prior to stocking juveniles in offshore systems.

TRANSFEREE SIGNATURE DATE SIGNED (MM/DD/YYYY)

/ /

PRINTED NAME POSITION IN COMPANY

8. SIGNATURE

I hereby declare under penalty of perjury that the foregoing information is true and correct (28 U.S.C. section 1746; 18 U.S.C. section 1621; 18 U.S.C. section 1001).

TRANSFEREE SIGNATURE DATE SIGNED (MM/DD/YYYY)

/ /

PRINTED NAME POSITION IN COMPANY

Public reporting burden for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or other suggestions for reducing this burden to PRA Officer, National Marine Fisheries Service. F/SER26, 263 13th Avenue South, St. Petersburg, FL 33701.

The National Marine Fisheries Service requires this information for the conservation and management of marine fishery resources. The data reported will be used to develop, implement, and monitor fishery management activities for a variety of other uses. Responses to this collection are required to obtain or retain a fisheries permit under the Magnuson-Stevens Act. Name and address information will be released via a NMFS website. All other data submitted will be handled as confidential material in accordance with NOAA Administrative Order 216-100, Protection of Confidential Fishery Statistics. Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control number.

Instructions for the Request for Transfer of Gulf Aquaculture Permit

1. Complete all sections of this application form. Applications should be typed. Incomplete or illegible applications will be returned.

2. Mail the completed request for transfer and all requiring supporting documentation to: NMFS (F/SER), Attn: Regional Aquaculture Coordinator, 263 13^th Avenue South, St. Petersburg, FL 33701.

APPLICATION SECTION 2 Eligibility for a Gulf Aquaculture permit is limited to U.S. citizens as defined in the Immigration and Nationality Act of 1952, as amended, and permanent resident aliens lawfully accorded the privilege of residing permanently in the U.S. in accordance with U.S. immigration laws.

APPLICATION SECTION 3 Include a copy of the Articles of Incorporation or Certificate of Limited Partnership or documentation of the formation of a General Partnership, if applicable.

APPLICATION SECTION 4 Provide a copy of the valid USCG certificate of documentation or, if not documented, a copy of the valid state registration certificate for each vessel as well as documentation or identification numbers for any aircraft or used to transport, harvest, transfer, or sale of cultured species at the approved site.

APPLICATION SECTION 5 Provide additional information as outlined.

APPLICATION SECTION 6 The transferee must abide by conditions as specified in 50 CFR XXXXX.

APPLICATION SECTION 7 The transferee must abide by conditions as specified in 50 CFR XXXXX.

APPLICATION SECTION 8 The transferee must sign and date this section for the request for transfer to be considered complete.

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File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Federal Offshore Aquaculture Permit for the Gulf of Mexico
Author	jess.beck
File Modified	0000-00-00
File Created	2021-01-28