FWS Form 3-200-24 Federal Fish and Wildlife Permit Application Form - Export of Live Captive-Born Animals and/Or Parts/Products From Non-native Species Under the Convention on International Trade in Endangered Species (Cites)

FWS Form 3-200-24 is a U.S. Department of the Interior - Fish and Wildlife Service form also known as the "Federal Fish And Wildlife Permit Application Form - Export Of Live Captive-born Animals And/or Parts/products From Non-native Species Under The Convention On International Trade In Endangered Species (cites)". The latest edition of the form was released in August 1, 2017 and is available for digital filing.

Download an up-to-date FWS Form 3-200-24 in PDF-format down below or look it up on the U.S. Department of the Interior - Fish and Wildlife Service Forms website.

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Form 3-200-24
OMB Control No. 1018-0093
Expires 08/31/2020
Department of Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form
Type of Activity
U.S. Fish and Wildlife Service
Division of Management Authority
EXPORT OF LIVE CAPTIVE-BORN ANIMALS AND/OR PARTS/
Branch of Permits, MS: IA
PRODUCTS FROM NON-NATIVE SPECIES under the Convention on
5275 Leesburg Pike
Falls Church, VA 22041-3803
International Trade in Endangered Species (CITES)
1-800-358-2104 or 703-358-2104
Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.
Instructions on how to make your application complete and help avoid unnecessary delays are attached.
Section A: Complete if applying as an individual
1.a. Last Name
1.b. First Name
1.c. Middle Name/Initial
1.d. Suffix
2. Date of Birth (mm/dd/yyyy)
3. Telephone Number
3.a. Alternate Telephone Number
4. E-mail address
Section B: Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution
1.b. Doing business as (DBA)
2. Tax identification no.
3. Description of business, agency, Tribe, or institution
4.a. Principal officer Last name
4.b. Principal officer First Name
4.c. Principal officer Middle name/initial
4.d. Suffix
5. Principal officer title
6. Primary contact name
7.a. Business telephone number
7.b. Alternate telephone number
7.c. Business fax number
7.d. Business e-mail address
Section C: All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City
1.c. State
1.d. Zip code/Postal code
1.e. County/Province
1.f. Country
2.a. Mailing address (include if different than physical address; include name of contact person if applicable)
2.b. City
2.c. State
2.d. Zip code/Postal code
2.e. County/Province
2.f.Country
Section D: All applicants MUST complete
Attach the nonrefundable application processing fee in the form of a check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the
1.
amount of $100. 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)].
2.
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 of applicant/Principal Officer for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)
Please continue to next page
Rev. 8/2017
Page 1 of 7
Form 3-200-24
OMB Control No. 1018-0093
Expires 08/31/2020
Department of Interior
U.S. Fish and Wildlife Service
Federal Fish and Wildlife Permit Application Form
Type of Activity
U.S. Fish and Wildlife Service
Division of Management Authority
EXPORT OF LIVE CAPTIVE-BORN ANIMALS AND/OR PARTS/
Branch of Permits, MS: IA
PRODUCTS FROM NON-NATIVE SPECIES under the Convention on
5275 Leesburg Pike
Falls Church, VA 22041-3803
International Trade in Endangered Species (CITES)
1-800-358-2104 or 703-358-2104
Complete Sections A or B, and C, D, and E of this application. U.S. address may be required in Section C, see instructions for details.
Instructions on how to make your application complete and help avoid unnecessary delays are attached.
Section A: Complete if applying as an individual
1.a. Last Name
1.b. First Name
1.c. Middle Name/Initial
1.d. Suffix
2. Date of Birth (mm/dd/yyyy)
3. Telephone Number
3.a. Alternate Telephone Number
4. E-mail address
Section B: Complete if applying on behalf of a business, corporation, public agency, Tribe, or institution
1.a. Name of business, agency, Tribe, or institution
1.b. Doing business as (DBA)
2. Tax identification no.
3. Description of business, agency, Tribe, or institution
4.a. Principal officer Last name
4.b. Principal officer First Name
4.c. Principal officer Middle name/initial
4.d. Suffix
5. Principal officer title
6. Primary contact name
7.a. Business telephone number
7.b. Alternate telephone number
7.c. Business fax number
7.d. Business e-mail address
Section C: All applicants complete address information
1.a. Physical address (Street address; Apartment #, Suite #, or Room #; no P.O. Boxes)
1.b. City
1.c. State
1.d. Zip code/Postal code
1.e. County/Province
1.f. Country
2.a. Mailing address (include if different than physical address; include name of contact person if applicable)
2.b. City
2.c. State
2.d. Zip code/Postal code
2.e. County/Province
2.f.Country
Section D: All applicants MUST complete
Attach the nonrefundable application processing fee in the form of a check or money order payable to the U.S. FISH AND WILDLIFE SERVICE in the
1.
amount of $100. 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)].
2.
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 of applicant/Principal Officer for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy)
Please continue to next page
Rev. 8/2017
Page 1 of 7
Form 3-200-24
OMB Control No. 1018-0093
Expires 08/31/2020
ARTS
ROM NON-NATIVE SPECIES
E
O
L
C
-B
A
A
P
/P
F
(CITES)
XPORT
F
IVE
APTIVE
ORN
NIMALS
NDOR
RODUCTS
Note 1: This application can be used to apply for a permit to export non-native live captive-born animals AND/OR parts
and products manufactured from such animals from the United States. If you are exporting parts or products
manufactured from native-listed species, such as bobcat or alligator, please use form
3-200-26
or 3-200-27.)
Note 2: The U.S. Fish and Wildlife Service may not be able to issue documents for the commercial export of Appendix-I
species, unless the specimens were produced at a CITES-registered Appendix-I commercial breeding operation. For more
information on registering an Appendix-I commercial breeding operation, contact the Division of Management Authority at
800-358-2104 or management_authority@fws.gov.
Provide the following information. Complete all questions on the application. Mark questions that are not applicable with
"N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you submit, indicate the
application question number you are addressing. If applying for more than one animal, be sure to indicate to which animal
the required documentation relates.
Electronic submission of inventories, photographs, and receipts: Some applications contain extensive inventories and/or a
large number of photographs or receipts. You may provide electronic versions of the documents. Such a submission will
assist in expediting the processing of your application since it may reduce data entry by the U.S. Fish and Wildlife Service.
If you wish to provide information electronically, once you have received an application number via the e-mailed
acknowledgment letter, e-mail your information to Permits@fws.gov. Be sure to include the application number provided
in the acknowledgment e-mail that will be sent to you when we receive your application.
I will be submitting documents electronically.
1. Name and address where you wish the permit to be mailed, if different from page 1. If you would like
expedited shipping, please enclose a self-addressed, pre-paid, computer-generated, courier service airway
bill. If unspecified, all documents will be mailed via regular mail through the U.S. Postal Service.
2. Who should we contact if we have questions about the application (name, phone number, and e-mail)?
3. Disqualification factor. A conviction, or entry of 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 disqualifies any
such person from receiving or exercising the privileges of a permit, unless such disqualification has been
expressly waived by the Service Director in response to a written petition. (50 CFR 13.21(c)) Have you or any
of the owners of the business, if applying as a business, been convicted, or entered a plea of guilty or nolo
contendere, forfeited collateral, or are currently under charges for any violations of the laws mentioned
above?
No
Yes
If you answered “Yes” to Question 3, 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.
Rev. 8/2017
Page 2 of 7
Form 3-200-24
OMB Control No. 1018-0093
Expires 08/31/2020
4. For EACH animal, part, or product to be exported, provide the below information (for your convenience, a
table has been provided on page 5 of this application):
a.
Scientific name (Genus, species, and, if applicable, subspecies) and common name;
b.
Birth/Hatch date (MM/DD/YYYY) (if live);
c.
Gender (if known) [male:female:unknown sex];
d.
Specimen is live or specimen is a part or product;
e.
Source;
f.
If live, microchip, tag, or band number, or other identifying characteristics;
g.
If parts or products, provide description of item(s).
5. Current location of specimen(s):
6. What is the purpose of the export?
____ Commercial
____ Personal ____ Exhibition
____ Scientific
____ Breeding ____ Other (specify: _____________________________)
7. Provide the name and address of the recipient of the shipment.
Name:
Address:
City, State/Province:
Country, Postal Code:
1
8. If you (the applicant) are the Breeder
of the specimen, sign (in ink) the following statement:
I hereby certify that the animal(s) and/or the parts or products listed above to be exported was/were bred and
born (if live), and/or were produced from animals bred and born from legally obtained parental stock at my facility
listed below
Name and address of your facility where the animals were bred and born:
Current location of parental stock (if different from above):
Signature______________________________________________
Date __________________
Rev. 8/2017
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Form 3-200-24
OMB Control No. 1018-0093
Expires 08/31/2020
9. If you are NOT the breeder
1
of the specimen(s), provide copies of documentation showing that you acquired
the animal and/or parts or products from the breeder (e.g., sales receipts), documentation demonstrating the
history of transactions (e.g., chain of ownership of each animal), and a signed and dated statement from the
breeder or breeder's record that clearly includes the following:
a.
Scientific name (genus, species, and, if applicable, subspecies) and common name;
b.
Statement that each animal was bred and born/hatched at his/her facility;
c.
Birth/hatch date (mm/dd/yyyy), and, if applicable, identification information (e.g., band#, microchip #);
d.
Name and address of the breeder’s facility; and
e.
Location (name of facility, address, city, State/province, postal code) of parental stock.
Please note that additional information on the parental stock may be required upon further review
1
of your application.
10. The transport conditions for live animals must comply with the CITES Guidelines for Transport of Live Animals
or, in the case of air transport, with the International Air Transport Association (IATA) live animal regulations
(contact airline for information). As such, describe:
a.
The type, size, and construction of any shipping container; and
b.
The arrangements for watering or otherwise caring for the wildlife during transport.
11. For the non-commercial export of CITES Appendix-I specimens, provide a copy of the CITES import
permit, OR evidence a permit will be issued by the Management Authority of the country to which you plan to
export the specimen(s). In accordance with Article III of the CITES treaty (www.CITES.org), it is required that
import permits are issued before the corresponding export permit. (Certain species have been certified as
“bred-in-captivity”, as identified in CITES Resolution Conf. 10.16 (Rev.), and would not require a CITES import
permit; please contact the Division of Management Authority if you are not sure if this designation would apply
to your specimens.)
12. For the commercial export of CITES Appendix-I species, Are you registered with the CITES Secretariat as an
operation that breeds Appendix I species for commercial purposes?
If yes, please provide your
Registration number:
(The export of specimens from a CITES-Registered Commercial Operation for Appendix I wildlife do not
require a CITES import permit).
13. Attach copies of any applicable State permits or licenses, such as State commercial breeding or sales
licenses (you may need to contact your State for information).
14. For the export of migratory birds (50 CFR 10.13) or their eggs, provide copies of your Federal and/or State
permits or licenses authorizing possession, acquisition, or disposition of such birds, or their eggs, where such
a permit is required.
15. If the species is part of an approved Wild Bird Conservation Act Cooperative Breeding Program, identify the
breeding operation, including the approval number, and provide an explanation of how the specimen is surplus
to the operation.
All international shipment(s) must be through a designated port.
A list of designated ports
(where
an 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).
Rev. 8/2017
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Form 3-200-24
OMB Control No. 1018-0093
Expires 08/31/2020
a. Scientific name (Genus, species,
b. Birth/Hatch date
c. Gender (if known)
d. Type of specimen
e. Source
f. Permanent marking if
g. Description of part or
and, if applicable, subspecies) and
(MM/DD/YYYY)(if
[male:female:unknown
(e.g., live, part or
(e.g., wild,
live, (e.g., microchip, tag,
product (e.g., leather goods,
common name;
live);
sex, (0.0.0)];
product)
captive-
band or other identifying
fur or feather items, etc.).
bred);
characteristics)
Rev. 8/2017
Page 5 of 7

Download FWS Form 3-200-24 Federal Fish and Wildlife Permit Application Form - Export of Live Captive-Born Animals and/Or Parts/Products From Non-native Species Under the Convention on International Trade in Endangered Species (Cites)

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