Form FDACS-15126 "Internal Audit of an Existing Sovereignty Submerged Land Live Rock Aquaculture Lease" - Florida

Form FDACS-15126 is a Florida Department of Agriculture and Consumer Services form also known as the "Internal Audit Of An Existing Sovereignty Submerged Land Live Rock Aquaculture Lease". The latest edition of the form was released in December 1, 2017 and is available for digital filing.

Download an up-to-date Form FDACS-15126 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-15126 "Internal Audit of an Existing Sovereignty Submerged Land Live Rock Aquaculture Lease" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Aquaculture
INTERNAL AUDIT OF AN EXISTING SOVEREIGNTY
SUBMERGED LAND LIVE ROCK AQUACULTURE LEASE
ADAM H. PUTNAM
COMMISSIONER
253.71, Florida Statute
LEASE AUDIT YEAR:
LEASE NUMBER:
LESSEE NAME:
FDACS STAFF USE ONLY
DATE OF AUDIT:
DUE DATE:
SECOND REQUEST DATE:
DATE RECEIVED:
CONTACT INFORMATION
Contact Full Name:
Aquaculture Certificate No.:
AQ -
Mailing Address:
City:
State:
Zip Code:
Telephone Number with Area Code:
Email Address:
*Important - If the Division of Aquaculture is unable to contact you it could result in your lease being
cancelled. If the information above is different from your current lease agreement documents, please
check the following box
and your contact information will be updated.
LIVE ROCK ACTIVITY
1. Are you currently subleasing to another certified Aquaculturist?
*All sublease transactions must be approved and executed by the Florida Department of Agriculture and
Consumer Services, Division of Aquaculture.
Yes
No
If "Yes", to whom:
Full Name of Person Subleased To:
Mailing Address:
Telephone Number with Area Code:
Date Sublease Expires:
FDACS-15126 Rev. 12/17
Page 1 of 4
Florida Department of Agriculture and Consumer Services
Division of Aquaculture
INTERNAL AUDIT OF AN EXISTING SOVEREIGNTY
SUBMERGED LAND LIVE ROCK AQUACULTURE LEASE
ADAM H. PUTNAM
COMMISSIONER
253.71, Florida Statute
LEASE AUDIT YEAR:
LEASE NUMBER:
LESSEE NAME:
FDACS STAFF USE ONLY
DATE OF AUDIT:
DUE DATE:
SECOND REQUEST DATE:
DATE RECEIVED:
CONTACT INFORMATION
Contact Full Name:
Aquaculture Certificate No.:
AQ -
Mailing Address:
City:
State:
Zip Code:
Telephone Number with Area Code:
Email Address:
*Important - If the Division of Aquaculture is unable to contact you it could result in your lease being
cancelled. If the information above is different from your current lease agreement documents, please
check the following box
and your contact information will be updated.
LIVE ROCK ACTIVITY
1. Are you currently subleasing to another certified Aquaculturist?
*All sublease transactions must be approved and executed by the Florida Department of Agriculture and
Consumer Services, Division of Aquaculture.
Yes
No
If "Yes", to whom:
Full Name of Person Subleased To:
Mailing Address:
Telephone Number with Area Code:
Date Sublease Expires:
FDACS-15126 Rev. 12/17
Page 1 of 4
2. Have you authorized or agreed to allow another party to use all or a portion of your lease?
Yes
No
If "Yes", to whom:
Full Name of Authorized Person:
Mailing Address:
Telephone Number with Area Code:
3. Have you submitted a current Authorized User Form (15107) to FDACS?
Yes
No
4. Have you transferred the lease parcel to another party?
*All lease transfers must be approved and executed by the Florida Department of Agriculture and Consumer
Services, Division of Aquaculture.
Yes
No
If "Yes", to whom:
Full Name of Person Transferred To:
Mailing Address:
Telephone Number with Area Code:
Date of Transfer:
If lease was transferred during the audit year, please complete the audit for the time period
you were the leaseholder.
5. Please fill in the pounds of live rock that were planted during January 1st through December 31st
of the specified audit year below. If no product was planted during the specified audit year,
enter “0”.
YEAR
ROCK TYPE
QUANTITY DEPOSITED (Pounds)
6. Please submit the following documentation with this audit. If the information is not
applicable in your case, please explain the reason(s) why in the space provided below.
a) Copies of rock purchase receipts or bills of sale showing the date and quantity of rock.
b) A lithologic description/sample for any rock products deposited that are not described in
previous descriptions/samples submitted to the State of Florida.
c) If natural rock materials were deposited, are those materials tagged?
Yes
No
d) How can you demonstrate that those rock materials are distinguishable from the native
rock within the immediate and general vicinity?
FDACS-15126 Rev. 12/17
Page 2 of 4
7. What is the minimum clearance above the highest elevation of culture material at mean low
water?
Feet:
Percent (%) of Water Column:
8. What percentage of the lease area is covered by culture material?
%
9. Estimated volume/pounds currently on lease site __________________________
. Please complete the section below by filling in the pounds of live rock harvested during
10
January 1st through December 31st of the specified audit year. If no product was harvested
during the specified audit year, enter “0”.
YEAR
ROCK TYPE
QUANTITY HARVESTED (Pounds)
If your response to question 5 or 10 above was “0”, please enter an explanation below.
11
.
FDACS-15126 Rev. 12/17
Page 3 of 4
You are required by your lease agreement to provide a complete audit response (the form must
be completely filled out, signed and dated, with the required supporting documentation
attached). Cancellation of the lease agreement may occur if no audit response is received, if the
audit response received is incomplete, or if the lease is not effectively cultivated.
CERTIFICATION
I hereby certify:
i.
that the information contained herein is true and correct;
ii.
that I, _______________________________________, have personal knowledge of the
requirements associated with the use of subject state-owned lands;
iii.
that the provided address shall be used for conducting official business with subject state
lands account;
iv.
that no marine life harvested from wild stocks is being utilized in conjunction with
aquaculture activities on this lease; and
v.
that I am authorized to execute this Audit and to perform aquaculture activities as
authorized by subject lease.
Lessee
Individual Lessee Signature:
Date:
Or Representative On Behalf of Lessee
Representative of Lessee Signature:
Date:
Signing capacity: ________________________________________________________________
(Please enter capacity in which signing the audit. If Lessee is a company or LLC, please enter
corporate or partner title; If signing on behalf of an estate, or power of attorney, please indicate
that authority).
FDACS-15126 Rev. 12/17
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