Request to Transfer Gulf Aquaculture Permit

Southeast Region Aquaculture Program

7 - Request to Transfer Gulf Aquaculture Permit (12-4-2015)

Request to Transfer Gulf Aquaculture Permit

OMB: 0648-0703

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OMB Control No. 0648-0703

Expiration Date:


REQUEST TO TRANSFER GULF AQUACULTURE PERMIT

Shape1

This form must be received by NOAA Fisheries

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) 551-5755 or email nmfs.ser.aquaculture@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


Shape3 Shape2 Shape4

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Shape5 Shape6 MAILING ADDRESS Apt/Suite #




Shape7 Shape8 Shape9 Shape10 CITY STATE COUNTY ZIP CODE





Shape11 Shape12 Shape13

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WORK TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS


  1. TRANSFEREE INFORMATION (NEW PERMIT HOLDER)


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

Shape14 Shape15 Shape16 Shape17


Shape18 Shape19 MAILING ADDRESS Apt/Suite #




Shape20 Shape21 Shape22 Shape23 CITY STATE COUNTY ZIP CODE






Shape25 Shape26 Shape24

( ) -


( ) -


HOME TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS



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

  1. TRANSFEREE BUSINESS INFORMATION


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


BUSINESS NAME MAILING ADDRESS

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Shape32 Shape33 Shape34 Shape31 CITY STATE COUNTY ZIP CODE



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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. Attach additional sheets as necessary.


OFFICER/PARTNER/DIRECTOR #1

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

Shape41 Shape40 Shape39 Shape38


Shape42 Shape44 Shape43 POSITION IN COMPANY MAILING ADDRESS Apt/Suite #


Shape46 Shape47 Shape48 Shape45 CITY STATE COUNTY ZIP CODE



Shape50 Shape51 Shape49

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HOME TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS



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


Shape53 Shape52

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OFFICER/PARTNER/DIRECTOR #2

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

Shape57 Shape56 Shape55 Shape54


Shape58 Shape60 Shape59 POSITION IN COMPANY MAILING ADDRESS Apt/Suite #


Shape62 Shape63 Shape64 Shape61 CITY STATE COUNTY ZIP CODE



Shape66 Shape67 Shape65

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( ) -


HOME TELEPHONE NUMBER CELL PHONE NUMBER EMAIL ADDRESS




Shape69 Shape68

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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 NOAA Fisheries Gulf Aquaculture permit in the past?

Shape70 Shape71

Yes No


If Yes, provide name and contact information for all person(s) who have applied for a permit in the past as well as the date the application was submitted to NOAA Fisheries.


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

Shape72 Shape73 Shape74 Shape75



Shape76 Shape77

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



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

Shape78 Shape79 Shape80 Shape81



Shape82 Shape83

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



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

Shape84 Shape85 Shape86 Shape87



Shape88 Shape89

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BUSINESS NAME (if applicable) 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?


Shape91 Shape90 Shape92 Yes No N/A


If Yes, provide the following information for each person(s).


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

Shape93 Shape94 Shape95 Shape96



Shape98 Shape97 PERMIT NUMBER FOR OTHER VERNTURE RELATIONSHIP TO VENTURE



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

Shape99 Shape100 Shape101 Shape102



Shape104 Shape103 PERMIT NUMBER FOR OTHER VERNTURE RELATIONSHIP TO VENTURE





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

Shape105 Shape106 Shape107 Shape108



Shape110 Shape109 PERMIT NUMBER FOR OTHER VERNTURE 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?

Shape112 Shape111

Yes No


If Yes, provide the information for each person(s). Include additional sheets with this information, if needed.


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

Shape113 Shape114 Shape115 Shape116



Shape118 Shape117

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



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

Shape119 Shape120 Shape121 Shape122



Shape124 Shape123

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

  1. TRANSFEREE VESSEL AND AIRCRAFT DOCUMENTATION


Provide all information for each vessel to be used for transport, harvest, transfer, or sale of cultured animals. 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

Shape125 Shape128 Shape126 Shape127


Shape130 Shape131 Shape132 Shape129 HOMEPORT CITY AND STATE PORT OF LANDING CITY AND STATE HOLD CAP. (TONS) LIVE WELL CAP. (GALLONS)

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VESSEL #1 OWNER INFORMATION CHECK ONE: INDIVIDUAL BUSINESS


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

Shape135 Shape136

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Shape139 Shape138 Shape140 Shape137 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


Shape143 Shape142 Shape141




VESSEL #2


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

Shape144 Shape147 Shape145 Shape146

Shape149 Shape150 Shape151 Shape148 HOMEPORT CITY AND STATE PORT OF LANDING CITY AND STATE HOLD CAP. (TONS) LIVE WELL CAP. (GALLONS)


Shape153 Shape152 VESSEL #2 OWNER INFORMATION CHECK ONE: INDIVIDUAL BUSINESS



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

Shape154 Shape155

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Shape158 Shape157 Shape159 Shape156 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


Shape162 Shape161 Shape160






  1. CERTIFICATION OF REMOVAL


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(Print Full Transferee Name)

I _____________________________ certify that I will remove all components of the aquaculture facility, including cultured animals remaining in allowable aquaculture systems from the Gulf EEZ if it is discovered that the organisms are genetically engineered or transgenic, that a World Organization of Animal Health (OIE)‑reportable pathogen or pathogen identified as reportable in the National Aquatic Animal Health Plan is found at the facility, or there are any other violations of the permit conditions or regulations which causes NOAA Fisheries to order such removal.


  1. 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 for the aquaculture facility 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.

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


  1. 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 NOAA Fisheries 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.




  1. 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)

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PRINTED NAME POSITION IN COMPANY

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Mail the completed form to:

NMFS Permits Office (F/SER14), Attn: Regional Aquaculture Coordinator,

263 13th Avenue South, St. Petersburg, FL 33701.


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. Non-confidential information may be released via a NOAA Fisheries website. Non-confidential information means: Name, Street Address, City, State, Zip Code, Effective Date of Permit, Permit Types, Vessel Name, Vessel Identification Number, and in the case of a “for hire” vessel the Passenger Capacity, or individual, corporate and lease holders of permits. 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. Incomplete or illegible applications will be returned.


  1. Mail the completed request for transfer and all requiring supporting documentation to: NMFS Permits Office (F/SER14), Attn: Regional Aquaculture Coordinator, 263 13th 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 8 The transferee must sign and date this section for the request for transfer to be considered complete.

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleFederal Offshore Aquaculture Permit for the Gulf of Mexico
Authorjess.beck
File Modified0000-00-00
File Created2021-01-24

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