Federal Permit Application for Aquacultured Live Rock (N

Instructions for the Federal Permit Application for Aquacultured
Live Rock (new permit)
Rev 11/01/2021
In addition to the instructions provided herein, applicants with specific questions are encouraged to contact the
Permits Office at (727) 824-5326 or toll free at (877) 376-4877 between 9:00 a.m. and 4:00 p.m. ET, or visit
the SERO Permits website at https://www.fisheries.noaa.gov/permits-and-forms.
Please consult the U.S. Code of Federal Regulations whose guidance for application requirements, permit
eligibilities, and related information will always prevail. NMFS will return incomplete or illegible applications.
Additional guidance regarding Aquacultured Live Rock is available on the web at:
http://sero.nmfs.noaa.gov/aquaculture/

General Instructions:
Aquacultured Live Rock (ALR) permits issued to one or more permit holders allow the deposition to and
harvest of materials at a specific geographic location, or site. Use this application to request an ALR permit for
a site that has not previously been issued an ALR permit,
To renew an ALR permit issued to the same permit holder(s) and for the same site, use the application titled
Federal Permit Application for Aquacultured Live Rock (renew permit).
If you wish to apply as a new permit holder for an already existing site, see section below on how to conduct
an ALR site transfer.
Under the current agreement between NMFS and the U.S. Army Corps of Engineers (USACE), the total
acreage of all aquacultured live rock sites maintained by a single permit holder in Federal waters off the coast
of Florida may not exceed 1.0 acres. Applicants desiring to maintain sites that exceed this 1.0 acre limit must
contact their local USACE office (http://www.usace.army.mil/Locations/) and inquire about the individual
permitting process for the deposit of aquacultured live rock in Federal waters off the coast of Florida.
What Sections do I complete?
Complete all applicable sections of this application form. All application fields should be typed or printed in ink.
Specifically,
All applicants must fill out Section 1.
All applicants must fill out Section 2a. If more than one vessel will be involved in the deposition or harvest of
materials from the site, fill out Section 2b. Copy Section 2 as necessary to provide information about all vessels
that may engage in the deposition or harvesting of materials from this site.
All applicants must fill out Section 3. If the ALR permit is to be issued to one or more individuals, fill out section 5a
for each individual to whom the permit is to be issued. If the ALR permit is to be issued to one or more
businesses, fill out section 3b for each business to whom the permit is to be issued. Copy Section 3 as
necessary to provide information about each individual or business requested to be an ALR Permit Holder.
If the USCG documentation or state registration for any vessel listed in Section 2a or 2b indicates the vessel is
owned by one or more individuals, fill out Section 4 for all individual owners of the vessel(s). Copy Section 4 as
necessary to provide information about all individuals that owner the vessel(s) listed in Section 2.
If the USCG documentation or state registration for any vessel listed in Section 2a or 2b indicates the vessel is
owned by one or more businesses, fill out Section 5 for all business owners of the vessel(s). Copy Section 5 as
necessary to provide information about all individuals that owner the vessel(s) listed in Section 2.
Complete Section 6 to provide information about all businesses that own a business listed in Section 3b, Section
5a, and/or Section 5b. Copy Section 6 as necessary to provide information about all business owners within the
ownership hierarchy of businesses requesting a permit or that own a vessel listed in this application.
Complete Section 7 for all individual owners and officers of businesses listed in Section 3b, Section 5a and b, and
Section 6a and b. Copy Section 7 as necessary to provide information about all individual owners and officers of
businesses that are requesting a new permit or that own a vessel listed in this application.
Complete Section 7c if any owners of the businesses listed in Section 3b, Section 5, or Section 6 hold an
ownership percentage less than 1%. This is not common.
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All applicants must complete Section 8 and Section 9.
See pages 3-6 for information about specific sections of this application.

What is the fee?
The application fee is $175. This application fee is collected to cover the administrative cost of processing the application,
and is non-refundable. The fee to replace a permit live rock permit is $18. NMFS will not refund money for denied permits.
A check or money order payable to the U.S. TREASURY must accompany each application.

Where do I send the application?
Mail the complete application, payment, and all required supporting documentation to: National Marine Fisheries
Service (F/SER14), 263 13th Avenue South, St. Petersburg, FL 33701. To receive permits via overnight carrier, enclose
a completed, pre-paid air bill and envelope. Please note using the prepaid overnight delivery option does not expedite
permit processing; it only expedites delivery of your completed permit package.

How do I transfer ownership of an existing Aquacultured Live Rock
If you are not the current permit holder for a particular site, you must include with this application a notarized statement
signed by you and the current owner of the site. The notarized statement must provide details on the transfer and include
the site number (e.g., AQU-XXX), latitude/longitude of the site, the full names and addresses and phone numbers of both
the transferor and transferee. Note that all deposit and harvest reports for the site must be received by the NOAA Fisheries
Permits Office and Florida Fish and Wildlife Research Institute, respectively, before the transfer can be finalized.

What supporting documentation do I need?
Documentation or state registration: Include a copy of the vessel’s valid USCG Documentation or, if not required to
be USCG Documented include a copy of the vessel’s valid State Registration, for each vessel listed in Section 4.
Payment: Include a check or money order made out to the US Treasury. See “What is the Fee” on page 1 of these
instructions for more information. Include a separate check or money order if requesting Floy tags for Golden Crab or
Sea Bass pots.
Sample Deposit Material: Provide a sample of the material to be deposited on the site for cultivation of live rock.
Nautical Chart: Applicant shall identify the site on a nautical chart, or portion thereof, with sufficient enough detail to
allow for site inspection, and shall provide accurate coordinates so that the site can be located by Global Positioning
System (GPS) equipment. The chart number, title and edition must be clearly labeled and the chart must be large
enough in scale to show sufficient detail to allow for site location and inspection.
U.S. Army Corps of Engineers Special Permit (if applicable): If the site(s) sites individually or cumulatively total
more than 1.0 acre you must include a U.S. Army Corps of Engineers (USACOE) special permit for depositing material
for the site(s).
Authorization from Florida Keys National Marine Sanctuary (if applicable). If the new site is located within the
Florida Keys National Marine Sanctuary, you must receive consent from the Florida Keys National Marine Sanctuary
(FKNMS) Permit Coordinator (joanne.delaney@noaa.gov, or (978) 471-9653). Provide documentation of this consent
with your application.

2

What about reporting compliance?
Deposit
Federal aquacultured live rock permit holders must report to the Permits Office after each deposition of material on a site.
Such reports must be postmarked no later than 7 days after deposition and must contain the following information:
• Permit number of site and date of deposit.
• Geological origin of material deposited.
• Amount of material deposited.
• Source of material deposited, that is, where obtained, if removed from another habitat, or from whom purchased.
The form “Report for the Deposit or Harvest of Aquacultured Live Rock” is available on our public website at
http://sero.nmfs.noaa.gov/operations_management_information_services/constituency_services_branch/permits/permit_a
pps/index.html
Harvest
If you are landing your harvested aquacultured live rock in Florida, you must report to the Fisheries Dependent
Monitoring Section of the Florida Fish and Wildlife Research Institute using standard form #33-610 (Marin Fisheries Trip
Ticket). Call the trip ticket office at (727) 896-8626 for more information.
You may use the “Report for the Deposit or Harvest of Aquacultured Live Rock” form only if you are landing harvested
aquacultured live rock outside of Florida.
NOTE: You may only conduct activity (e.g., deposition, harvest) on your site in years when you have an active federal
Aquacultured Live Rock permit.

APPLICATION SECTION 1 – SITE INFORMATION.
Complete all fields in this section.
This section must be prepared by an independent source in a manner pursuant to generally accepted industry
standards, and shall demonstrate that the proposed site:
Is not a hazard to safe navigation or a hindrance to vessel traffic
Avoids traditional fishing operations, or other public access
Avoids impacts to naturally occurring hard bottom habitat and submerged aquatic vegetation; and
Contains natural underlying substrata that is primarily hard packed sand, hard shell hash, or less than 6-12
inches of sand over rock.
Provide a description of the site, as requested in sections 1a – 1d.
Provide information about the independent surveyor who performed the site inspection.
You may provide a supplemental report by the independent surveyor if such a report augments the descriptions
in this section.

APPLICATION SECTION 2 – VESSEL INFORMATION.
Complete Section 2 for all vessels to be permitted to deposit or harvest of materials from the site. Copy this
page as necessary to provide information about all vessels.
Enter the Official Number and the length of the vessel as they appear on the U.S. Coast Guard Certificate of
Documentation, or the State Registration certificate for a vessel without USCG documentation.
Provide the Hull Identification Number (HIN) if available. The HIN is a unique number assigned by the boat builder.
Most HINs are shown on the state registration or USCG documentation.
Provide hailing port or home port of the vessel in the fields provided.
Provide information about the Port of Landing, which is where the vessel will land the harvested aquacultured live
rock, in the fields provided.
For USCG documented vessels, provide the gross and net tonnage in the fields provided.
Provide information about the vessel’s physical characteristics in the fields provided.

3

APPLICATION SECTION 3 – PERMIT HOLDER INFORMATION.
Provide information about the individual(s) or business(es) to be listed as the permit holder. For individual
permit holders, fill out section 3a. For business permit holders, complete Section 3b. If there is more than
one permit holder, select a single Primary Mailing Recipient to whom all correspondence about this application
and requested permits will be sent. Copy Section 3 as necessary to provide information about all individuals and
businesses to be a permit holder. Specifically,
Section 3a
• For each individual permit holder, include the lessee’s full name, Individual Tax ID number (SSN), date of birth,
phone number, email address, mailing address, physical address, sex, and race/ethnicity information.
• Indicate if the Individual is a United States citizen or permanent resident alien. Note, this information will not
affect eligibility to obtain a permit.
• An Email address is required in order to approve and issue permits.
Section 3b
• For each business that la permit holder, provide the business’s full name, Federal Employer Tax ID number
(FEIN), date the business was formed, phone number, email address, mailing address, physical address,, and
business type.
• An Email address is required in order to approve and issue permits.
• Indicate if the business was established by the laws of the United States or any state of the United States. Note,
this information will not affect eligibility to obtain a permit.
• For a brief definition of applicable business types, see our frequently asked questions at
http://sero.nmfs.noaa.gov/operations_management_information_services/constituency_services_branch/permits/
permit_faq/index.html

APPLICATION SECTION 4 -- INDIVIDUAL VESSEL OWNERS.
For each vessel listed in Section 2 that is owned by one or more individuals (as listed on the vessel’s U.S.
Coast Guard Certificate of Documentation or State Registration), complete Section 4 for all individual owners
listed. Complete Section 4a for an individual owner. Also fill out Section 4b if the vessel is jointly owned
by another individual. Photocopy Section 4 as necessary to provide information for all individuals that own
the vessel.
For each owner, provide the owner’s full name, Individual Tax ID number (SSN), date of birth, phone number,
physical and mailing address, sex, and race/ethnicity information.
Indicate if the owner is a United States citizen or permanent resident alien. Note, this information will not affect
eligibility to obtain a permit.

APPLICATION SECTION 5 – BUSINESS VESSEL OWNERS.
For each vessel listed in Section 2 that is owned by one or more businesses (as listed on the vessel’s U.S.
Coast Guard Certificate of Documentation or State Registration),complete section 5 for all business owners
listed. Complete section 5a for a single business owner. Also fill out Section 5b if the vessel is jointly
owned by another business.
NMFS will not issue permits to a business with an INACTIVE status with the applicable Secretary of State.
Provide the business’s full name, Federal Employer Tax ID number (FEIN), date the business was formed, phone
number, physical and mailing address, and business type.
Indicate if the business was established by the laws of the United States or any state of the United States. Note,
this information will not affect eligibility to obtain a permit.
For a brief definition of applicable business types, see our frequently asked questions at

permit_faq/index.html

4

Company A

Company B

APPLICATION SECTION 6 –Businesses that Own Businesses
Complete this section for any business that owns more than 1% of any business listed within the
ownership hierarchy of vessel owners or permit holders, as listed in Section 3b, or Section 5. For every
business, the sum of ownership, by either individuals or other businesses, must total 100%. Photocopy
this section as necessary to provide information about all businesses within the ownership hierarchy
of the vessel.

For each business, provide the business’s full name, Federal Employer Tax ID number (FEIN),
date the business was formed, phone number, physical and mailing address, and business type.
Indicate if the business was established by the laws of the United States or any state of the United States.
Note, this information will not affect eligibility to obtain a permit.
For a brief definition of applicable business types, see our frequently asked questions at
permit_faq/index.html
Example: If a vessel’s USCG documentation indicates that the vessel is owned by Company A, and Company A
is owned by Company B. Provide information about Company A in section 5 and Company B in section 7.

APPLICATION SECTION 7 –Businesses Officers and Individual Owners
Complete this section for any individual that owns more than 1% of any business listed in Section 3b,
Section 5, or Section 6. For every business, the sum of ownership, by either individuals or other
businesses, must total 100%. Photocopy this section as necessary to provide information about all
businesses within the ownership hierarchy of the vessel
• For each individual owner or officer, include the entity’s full name, Individual Tax ID number (SSN), date of birth,
phone number, physical address, mailing address, sex, and race/ethnicity information.
• Indicate if the individual is a United States citizen or permanent resident alien. Note, this information will not
affect eligibility to obtain a permit.

Example: If a vessel’s USCG documentation indicates that the vessel is owned by Company A, provide
information about all owners and officers of Company A. If Company A is also owned in whole or part by
Company B, complete section 8 to provide information about all individual owners and officers of Company A and
Company B.
Photocopy this section as necessary to provide information about all businesses and their respective owners and
officers that comprise the ownership hierarchy of the vessel.
Minor shareholders

Section 7C is left blank for most applicants. Complete Section 7C if a business listed in Section 3b, 5, 6, or 7 has
owners that individually own less than 1% of the business. Provide the total percentage of ownership which is
individually held by owners who own less than 1%.
APPLICATION SECTION 12 – Small Business or Organization Certification
This section is required for ALL applicants. Your revenue and employment estimates for the most recent complete
calendar year your business or organization was active should include the revenues and employees of ALL affiliated
businesses or organizations. In general, businesses or organizations are affiliated with each other when one
business or organization controls or has the power to control another business or organization, or a third party
controls or has the power to control both. Specifically, businesses or organizations are considered to be affiliated if
they have 50% or more ownership in common. For e.g., if the same individual or individuals own or co-own multiple
businesses, those businesses would be considered affiliated and thus should be treated as a single operation for the
purpose of estimating annual gross revenues and employment.
APPLICATION SECTION 9 – SIGNATURE FOR APPLICATION
The signatory for a coral permit must be the individual who will be conducting the activity that requires the permit.
In the case of a corporation or partnership that will be conducting live rock aquaculture activity, the signatory must
be the principal shareholder or a general partner.
5

KNOWINGLY SUPPLYING FALSE INFORMATION OR WILLFULLY OVERVALUING ANY FISHING INCOME TO OBTAIN A
PERMIT IS A VIOLATION OF FEDERAL LAW PUNISHABLE BY A FINE AND/OR IMPRISONMENT.
Public Burden Statement - A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a
penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information
collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0648-0205. Without this
approval, we could not conduct this survey or information collection. Public reporting for this information collection is estimated to be approximately 70
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the information collection. All responses to this information collection are required to obtain benefits. Send comments regarding
this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the: PRA Officer, National Marine
Fisheries Service, F/SER26, 263 13th Avenue South, St. Petersburg, FL 33701.
Privacy Act Statement - Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and Management
Act (16 U.S.C 1801 et seq.), the High Seas Fishing Compliance Act, the Tuna Conventions Act of 1950, the Antarctic Marine Living Resources Convention
Act, the Western and Central Pacific Fisheries Convention Implementation Act (16 U.S.C. 6901 et seq.), the Marine Mammal Protection Act, the
Endangered Species Act and the Fur Seal Act. The authority for the mandatory collection of the Tax Identification Number (TIN) is 31 U.S.C. 7701.
Purpose: In order to manage U.S. fisheries, the National Marine Fisheries Service (NMFS) requires the use of permits or registrations by participants in
the United States. Information on NMFS permit applicants and renewing holders includes vessel owner contact information, date of birth, TIN and vessel
descriptive information. Permit holder information may be used as sampling frames for surveys, as part of Fishery Management Council (FMC) analysis to
support FMC decisions.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery participants. Disclosure of this information is
permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be shared within NMFS offices, in order to coordinate monitoring and management of
sustainability of fisheries and protected resources, as well as with the applicable state or regional marine fisheries commissions and international
organizations. Disclosure of this information is also subject to all of the published routine uses as identified in the Privacy Act System of Records Notice
COMMERCE/NOAA-19, Permits and Registrations for the United States Federally Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate information will prevent the determination of
eligibility for a permit.

6

OMB Control Number 0648-0205; Expiration date 01/31/2024

U.S. Department of Commerce, NOAA
NMFS PERMITS OFFICE, F/SER14
263 13th Avenue South
St. Petersburg, FL 33701
Toll Free 877-376-4877 (9:00 a.m. - 4:00 p.m. ET)
727-824-5326 (9:00 a.m. - 4:00 p.m. ET)
https://www.fisheries.noaa.gov/permits-and-forms

FEDERAL PERMIT APPLICATION FOR
AQUACULTURED LIVE ROCK (NEW)
FOR OFFICE USE ONLY
Reviewer Initials and date
Check or Money Order
Number and Amount
New Site Number

FOR OFFICE USE ONLY

Expiration date

Application ID

Application Fees:

New: $175

SCAN DATE AND INITIALS

SECTION 1 - SITE INFORMATION
Is this a new or established site?

New

Established

NMFS Site number: AQU-

If this is a new site,
leave blank—NMFS
will assign a number.

NOTE: If this is an established site and the applicant is not the current permit holder, the applicant must complete the site trans fer requirements outlined in the instructions.
Site Location:
Latitude and Longitude must be reported as Degrees-Minutes to the third decimal place (i.e. 24-32.123 N 085-45.456 W)

Longitude Center Point

Latitude Center Point

Method of determining latitude and longitude

GPS

DGPS

This site is located off the state of:

Radius ( not to exceed 117.75 feet )

Ft.

Minimum depth of water over the site at mean
low water - reported in feet.

Ft.

SITE SURVEY REQUIREMENT
1a. Description of the site location (i.e. 5.5NM SW of Rock key and .75NM east of Sand Shoal)

1b. Describe the naturally occurring bottom habitat at the site:

1

ASE2021.2x; Form Revision 11/01/2021

SITE SURVEY REQUIREMENT (continued)
1c. Describe all possible hazards to safe navigation or hindrance to vessel traffic, interference with traditional fishing operations or other public access that may
result from aquacultured live rock operations at the site.

1d. Describe the type, size, total amount and geological origin of the material to be deposited on the site and how it will be distinguishable (method of marking/
tagging) and description) from the naturally occurring substrate. YOU MUST PROVIDE A SAMPLE OF THE MATERIAL.

SURVEYOR INFORMATION
Company Name

Mailing Address

Area Code

Apt #

City

State

Phone Number

County/Parish

Zip Code

I Certify that this survey information is true and correct to the best of my training, education and ability.
Date Signed

Surveyor Signature

Position in Company

Printed Name
Qualifications/experience of Surveyor:

2

Country

SECTION 2 - VESSEL INFORMATION
Copy this page as needed to provide information for each vessel that is designated to deposit or harvest of live rock material. A vessel may not
be used for depositing or harvesting of material if it is not included on the application.

SECTION 2a - Primary Vessel Information
Official Number From USCG Certificate Of Documentation

State Registration Number (as applicable)

Vessel Name

Year Built

Hull Identification Number

Length (ft)

Crew Size - Including the Captain
ALL APPLICANTS—HOLD or FISH BOX CAPACITY: Estimate
How many pounds of product can you bring to the dock with
a full hold or fish boxes (including ice chests)?

Hailing Port City

Hailing Port County Or Parish

Hailing Port State

Port of Landing City

Port of Landing State

LIVE WELL CAPACITY: How many gallons of water
does your live well hold?
Hull Material
FIBERGLASS
STEEL

USCG DOCUMENTED VESSELS ONLY
Gross Tons

Total Horsepower

Net Tons

Fuel Data
Fuel Capacity -

DIESEL

Total Gallons

GASOLINE

WOOD

OTHER
(DESCRIBE)

CEMENT

International Maritime Organization (IMO) Number
As applicable (see instructions)

OTHER
(DESCRIBE)

SECTION 2b - Additional Vessel Information
Official Number From USCG Certificate Of Documentation

State Registration Number (as applicable)

Vessel Name

Year Built

Hull Identification Number

Length (ft)

Crew Size - Including the Captain
ALL APPLICANTS—HOLD or FISH BOX CAPACITY: Estimate
How many pounds of product can you bring to the dock with
a full hold or fish boxes (including ice chests)?

Hailing Port City

Hailing Port County Or Parish

Hailing Port State

Port of Landing City

Port of Landing State

LIVE WELL CAPACITY: How many gallons of water
does your live well hold?
Hull Material
FIBERGLASS
STEEL

USCG DOCUMENTED VESSELS ONLY
Gross Tons

Total Horsepower

Net Tons

WOOD
CEMENT

International Maritime Organization (IMO) Number
As applicable (see instructions)

OTHER
(DESCRIBE)

3

Fuel Data
DIESEL
GASOLINE
OTHER
(DESCRIBE)

Fuel Capacity Total Gallons

SECTION 3 - PERMIT HOLDER INFORMATION
Complete Section 3a on this page for an individual that is an Aquacultured Live Rock Permit Holder. Complete section 3b fo Aquacultured Live
Rock Permit Holder. Photocopy this page as needed to provide information on all permit holders. Select o recipient. Note: Please refer to the
instructions to see limitations on total site acerage for a single permit holder.
Section 3a: Individual is an Aquacultured Live Rock Permit Holder. Complete this section is a individual is the permit holder.

All mail about the permit will go to the individual listed in Section 3a
Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

Is this individual a United States Citizen
or permanent resident alien?
What this individual’s
Sex?

No

Yes

YES

Male

Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Last Name

NO

Suffix - Jr, Sr, etc.

Middle Name

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Individual Tax ID Number (SSN)

Date of Birth (MM/DD/YYYY)

Area Code

Phone Number

Email Address - REQUIRED
Mailing Address

Apt #

City

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Section 3b: Business as an Aquacultured Live Rock Permit Holder: Complete this section if a business is the permit holder.

Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

MAILING RECIPIENT - All mail about this permit
will go to the business listed in Section 3b
Registered Name of Business

Federal Employer Tax ID Number (FEIN)

Date Business Formed (MM/DD/YYYY)

Area Code

Phone Number

Email Address - REQUIRED
Mailing Address

Apt #

City

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

4

YES
NO

SECTION 4 - INDIVIDUAL VESSEL OWNER(S) INFORMATION
Section 4a: Primary or Sole Owner: Complete this section if there is one or more individual sshown on the USCG documentation, State
Registration or title as the registered owner of the vessel. Select only ONE mailing recipient.
Is this individual a United States Citizen
or permanent resident alien?
Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

What is this
individual’s Sex?

No

Yes

Male

YES

Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

First Name

Last Name

Middle Name

NO

Suffix - Jr, Sr, etc.

If you are operating under a different name,
what is your Doing Business As (DBA) name?
Individual Tax ID Number (SSN)

Date of Birth (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Section 4b: Joint Owner. Complete this section if there is more than one individual shown on the USCG documentation, State Registration or
title as the registered joint owner of the vessel. Copy this page as needed to include ALL owners of the vessel.
Is this individual a United States Citizen
or permanent resident alien?
Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

No

Yes

What is this
individual’s Sex?

Male

YES
Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

First Name

Middle Name

Suffix - Jr, Sr, etc.

If you are operating under a different name,
what is your Doing Business As (DBA) name?

Individual Tax ID Number (SSN)

Mailing Address

Date of Birth (MM/DD/YYYY)

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

5

NO

SECTION 5 – BUSINESS VESSEL OWNER(S) INFORMATION
Photocopy this page as needed to provide ownership

Vessel Number (USCG or State number)

information for all vessels listed in section 2. Use a separate
page for each vessel.

Section 5a: Primary or Sole Owner: Complete this section if there is one or more businesses shown on the USCG Documentation, State
Registration or Title as the registered owner of the vessel. Select only ONE mailing recipient.

Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

YES
NO

MAILING RECIPIENT - All mail about this permit will go to the business listed in Section 5a
Registered Name of Business

Federal Employer Tax ID Number (FEIN)

Mailing Address

Date Business Formed (MM/DD/YYYY)

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Section 5b: Joint Owner: Complete this section if there is another business shown on the USCG Documentation, State Registration or
Title as the registered joint owner of the vessel.
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

MAILING RECIPIENT - All mail about this permit will go to the business listed in Section 5a
Registered Name of Business

Federal Employer Tax ID Number (FEIN)

Mailing Address

Date Business Formed (MM/DD/YYYY)

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

6

YES
NO

SECTION 6 - BUSINESSES THAT OWN BUSINESSES
Complete this section for each business that owns 1% or more of a business listed in sections 3b and/or section 5. Copy this section as needed.

Section 6a: Business owner:

Business for which this business is an owner of:
Percent of Business Owned:
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

YES
NO

Registered Name of Business

Federal Employer Tax ID Number (FEIN)

Date Business Formed (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Section 6b: Additional Business owner:

Business for which this business is an owner of:
Percent of Business Owned:
Type of
business:

S Corporation

Cooperative

Other_______________

C Corporation

Limited Liability Co.

Partnership

Was this Business properly established by
the laws of the United States or any state
of the United States?

Registered Name of Business

Federal Employer Tax ID Number (FEIN)

Mailing Address

Date Business Formed (MM/DD/YYYY)

Apt #

City

Area Code

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

7

YES
NO

SECTION 7 - BUSINESS OFFICERS AND INDIVIDUAL OWNERS
Complete this section by providing information on all individual officers and owners that own 1% or more of any business listed in sections 3b, 5, and 6. Copy this
section as needed.

Section 7a: Individual Officer/Owner:
Business for which this individual is an officer/owner of:
Position Held - Check ALL That Apply
Vice President
President/CEO
Percent of Business Owned:

Secretary

Director/ Manager

Shareholder

Other
YES

Is this individual a United States citizen or permanent resident

Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

Treasurer

No

Yes

What is this
individual’s Sex?

Male

Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Middle Name

First Name

Last Name

Individual Tax ID Number (SSN)

Date of Birth (MM/DD/YYYY)

Mailing Address

Apt #

City

Area Code

NO

Suffix - Jr, Sr, etc.

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

Section 7b: Additional Officer/Owner:
Business for which this individual is an officer/owner of:
Position Held - Check ALL That Apply
President/CEO

Vice President

Percent of Business Owned:

Secretary

Director/ Manager

Shareholder

Other
YES

Is this individual a United States citizen or permanent resident

Is this Individual of Hispanic, Latino, or Spanish origin?
What is this
individual’s
race?

Treasurer

No

Yes

What is this
individual’s Sex?

Male

Female

White

American Indian or Alaska
Native

Native Hawaiian or Other Pacific Islander

Black or African American

Asian American

Other _______________

Last Name

Individual Tax ID Number (SSN)

Mailing Address

Middle Name

First Name

Date of Birth (MM/DD/YYYY)

Apt #

City

Area Code

Suffix - Jr, Sr, etc.

Phone Number

State

County/Parish

Zip Code

Country

State

County/Parish Zip Code

Country

Check box if the Physical Address is the same as the mailing address.
Physical Address (PO Box not acceptable)

Apt #

City

8

NO

SECTION 7 - OFFICER/OWNER INFORMATION FOR BUSINESS(ES) THAT OWN OR LEASE THE VESSEL (cont.)
7c. Minor Owner Information
MINOR OWNERS - Check here if one or more owners individually holds shares that is less than 1% of the total business shares.
TOTAL PERCENTAGE of the business shares held by minor owners.

SECTION 8 - SMALL BUSINESS OR ORGANIZATION CERTIFICATION
ALL applicants must complete this section. This section applies to the permit holder as listed in section 4.
Information needed to complete this section: Please estimate your annual gross revenues (sales) for the most recent calendar
year your business or organization was active prior to this year. Your primary activity is the activity that generated the greatest
percentage of annual gross revenues in the most recent complete calendar year the business or organization was active. Review
the business/organization descriptions in Boxes 1 through 7 and identify the one that describes the applicant’s primary activity. If
the business is primarily a seafood dealer or processor, estimate the number of employees for the most recent calendar year your
business or organization was active prior to this year. Include all full-time, part-time, and temporary employees in your estimate,
but do not include crew that work on any vessels owned by the business or organization or its affiliates. Your estimates should account for the revenues and employees of ALL businesses and organizations with which your business or organization is affiliated.
See the instructions at the beginning of the application package for more information about affiliation. If you have questions about
affiliation and how it applies in your case, please call 727-824-5305 and ask for one of our Office’s economists.
How to fill out the form: Start with Box 1. If the answer to the question in Box 1 is “Yes,’’ check “Yes” and answer the questions in
the box to the right and follow the instructions in that box. If the answer to Question 1 is “No,” check “No” and go to Box 2. Continue this process until you have either: (1) answered “Yes” to ONE of the questions in Boxes 1 through 6 AND the applicable questions in the boxes to the right, OR (2) answered all questions in Box 7.
Box 1. Is the business primarily involved in
harvesting seafood (commercial fishing)?

1A) Was the business active prior to
this year?

Yes

Yes

No

No

If the answer is yes, go to question 1A to the
right. Otherwise, go to Question 2 below.

If yes, go to question 1B. If no, you
are done. Go to Section 9 of the
application.

Box 2. Is the business primarily involved in
for-hire fishing services (charter, party/
headboat)?

2A) Was the business active prior to
this year?

Yes

No

If the answer is yes, go to question 2A to the
right. Otherwise, go to Question 3 below.

Box 3. Is the business primarily involved in
buying and selling seafood (seafood
dealer/wholesaler)?
Yes

No

Yes

No

If yes, go to question 2B. If no, you
are done. Go to Section 9 of the
application.

3A) Was the business active prior to
this year?
Yes

No

If the answer is yes, go to question 3A to the
right. Otherwise, go to Question 4 below.

If yes, go to question 3B. If no, you
are done. Go to Section 9 of the
application.

Box 4. Is the business primarily involved in
processing seafood (seafood processor)?

4A) Was the business active prior to
this year?

Yes

Yes

No

If the answer is yes, go to question 1A to the
right. Otherwise, go to Question 5 on the next
page.

No

If yes, go to question 4B. If no, you
are done. Go to Section 9 of the
application.

Next page
9

1B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than $11 million in
gross receipts in that year? Yes
No
You are done. Go to Section 9 of the
application.

2B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than $8 million in
gross receipts in that year? Yes
No
You are done. Go to Section 9 of the
application.

3B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than 100
employees? Yes
No
You are done. Go to Section 9 of the
application.

4B) What was the most recent year the
business was active prior to this year?
_____________
Did the business have more than 750
employees? Yes
No
You are done. Go to Section 9 of the
application.

SECTION 8 - SMALL BUSINESS OR ORGANIZATION CERTIFICATION

Box 5. Is the organization an Environmental,
Conservation and Wildlife, or Professional
Non-Profit Organization?
Yes

No

If the answer is yes, go to question 5A to the
right. Otherwise, go to Question 6 below.

Box 5. Is the organization some other NonProfit Organization (e.g., business association)?
Yes

No

If the answer is yes, go to question 6A to the
right. Otherwise, go to Question 7 below.

5A) Was the organization active
prior to this year?
Yes

No

If yes, go to question 5B. If no, you
are done. Go to Section 9 of the
application.

6A) Was the organization active
prior to this year?

Yes

No

If yes, go to question 6B. If no, you
are done. Go to Section 9 of the
application.

5B) What was the most recent year the
organization was active prior to this year?
_____________
Did the organization have more than $15
Million in gross receipts? Yes
No
You are done. Go to Section 9 of the
application.

6B) What was the most recent year the
business was active prior to this year?
_____________
Did the organization have more than $7.5
Million in gross receipts? Yes
No
You are done. Go to Section 9 of the
application.

7) The business or organization must be primarily involved in another industry not related to fishing or seafood.
Refer to SBA’s list of North American Industry Classification System (NAICS) codes
(see https://www.sba.gov/document/support--table-size-standards ) and enter the NAICS code for your primary activity here:

Based on the applicable SBA size standard, check the appropriate box to indicate if the business or organization is Large or Small and
report the year on which that conclusion was based.

Large

Small

Year:

STOP! You are done.

SECTION 9 - SIGNATURE FOR APPLICATION - REQUIRED
The undersigned certifies under penalty of perjury that the foregoing information is true and correct (28 USC 1746; 18 USC 1621;
18 USC 1001, 16 USC 1857).
The applicant must be an individual named as permit holder in Section 3a, or an officer or shareholder of the business listed in
Section 3b as the permit holder.
Applicant Signature

Position in Business

Print Name

10

Date