FWS Form 3-200-76 "Federal Fish and Wildlife Permit Application Form - Export of Caviar or Meat of Paddlefish or Sturgeon Removed From the Wild Under the Convention on International Trade in Endangered Species (Cites)"

What Is FWS Form 3-200-76?

This is a legal form that was released by the U.S. Department of the Interior - Fish and Wildlife Service on August 1, 2017 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest available edition released by the U.S. Department of the Interior - Fish and Wildlife Service;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of FWS Form 3-200-76 by clicking the link below or browse more documents and templates provided by the U.S. Department of the Interior - Fish and Wildlife Service.

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Download FWS Form 3-200-76 "Federal Fish and Wildlife Permit Application Form - Export of Caviar or Meat of Paddlefish or Sturgeon Removed From the Wild Under the Convention on International Trade in Endangered Species (Cites)"

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Form 3-200-76
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
U.S. Fish and Wildlife Service
Type of Activity
Division of Management Authority
EXPORT OF CAVIAR OR MEAT OF PADDLEFISH OR
Branch of Permits, MS: IA
STURGEON REMOVED FROM THE WILD under the Convention
5275 Leesburg Pike
Falls Church, VA 22041-3803
on 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 identified on page 2 or 3. 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 3-200-76
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
U.S. Fish and Wildlife Service
Type of Activity
Division of Management Authority
EXPORT OF CAVIAR OR MEAT OF PADDLEFISH OR
Branch of Permits, MS: IA
STURGEON REMOVED FROM THE WILD under the Convention
5275 Leesburg Pike
Falls Church, VA 22041-3803
on 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 identified on page 2 or 3. 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 3-200-76
OMB Control No. 1018-0093
Expires 08/31/2020
E. Export of Caviar or Meat of Paddlefish or Sturgeon Removed from the Wild (CITES)
NOTE: To ensure the most relevant application is being submitted, please review the following before completing this
form. To request export of live specimens removed from the wild submit form 3-200-27; export of aquacultured
specimens submit form 3-200-24; re-export of specimens submit form 3-200-73; or export or re-export of species listed
under the U.S. Endangered Species Act submit form 3-200-37.
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.
Complete all questions on the application. Mark questions that are not applicable with "N/A". If needed, use
separate sheets of paper. On all attachments or separate sheets you submit, indicate the application question
number you are addressing.
4. What type of authorizations are you requesting?
Single shipment for export. If approved, a single permit for a specific amount of caviar will be issued.
The processing fee is $100 per application.
Rev. 8/2017
Page 2 of 7
Form 3-200-76
OMB Control No. 1018-0093
Expires 08/31/2020
Provide the name and address of person/facility receiving the shipment (if self, provide address abroad).
Name:
Address:
City:
State/Province:
County, Postal Code:
Multiple shipments of identical amounts. For multiple shipments of identical amounts, the Service can
establish a
master
file. If the master file is approved, you can obtain a number of single-use permits, valid for 6
months, for each export (50 CFR 13.11, see attached). The processing fee is $200.
To obtain single use permits from the master file, complete below:
i.
Total weight of caviar you are requesting to be authorized: ____________.
ii.
How many permits do you anticipate using in the next 6 months? _________. (Provide $5 for each
6-month permit; you may provide this after the master file is approved).
iii.
Amount you are requesting on each permit: ____________(must be identical for each permit.)
(EXAMPLE: TOTAL AMOUNT = 100 KG; 4 PERMITS; 25 KG EACH.)
iv.
Note, you may either fill in the recipient at the time of export or you may indicate a recipient that will
appear on all permits issued:
Do not include recipient name on the issued permits.
Include the following name on each permit:
Name:
Address:
City:
State/Province:
County, Postal Code:
5. For EACH product to be exported, provide:
a.
Scientific name (genus, species, and if applicable, subspecies) and common name of the fish:
b.
State(s) and water body of harvest of source specimens, if not found on State harvest report:
c.
Product description (caviar or meat):
d.
Weight (in metric and standard units):
Rev. 8/2017
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Form 3-200-76
OMB Control No. 1018-0093
Expires 08/31/2020
e.
Shipping containers to be used (e.g., jars, tins, buckets) and sizes (provide units):
f.
Shipment will be fresh, frozen, pasteurized, or other (describe):
requirements) in CITES universal labeling system format.
g.
If caviar, provide list of labels (see
caviar labeling
h.
Current location of specimen(s):
6. Does this application request authorization to export a portion of a product(s) that was authorized under a
previous permit?
No. If no, continue to question 9.
Yes. If yes, complete a. below and continue to questions 9-12.
a. Provide a copy of the original CITES export permit and cleared 3-177 declaration form obtained when you
exported a portion of the previously authorized product, and complete and sign (in ink) the following
statement: I hereby certify that the product pertaining to this current application is a portion of product
previously authorized for export under permit number _______________________.
(fill in permit number)
Signature ____________________________________ Date _____________________
Questions 7 through 12 must be answered for the ENTIRE quantity of product(s) listed in your application. By signing
this application, you are certifying that all the information provided in support of this application is complete and
accurate, including any and all information provided about suppliers, dealers, and fishers.
7. List ALL intermediary suppliers’ and/or dealers’ names, addresses, State permit numbers, type of product
(i.e., meat or caviar), and weight of product obtained from each supplier (attach additional sheets of paper as
necessary):
Name:
Address:
City:
State/Province:
County, Postal Code:
State permit number:
Total weight of product supplied:
Rev. 8/2017
Page 4 of 7
Form 3-200-76
OMB Control No. 1018-0093
Expires 08/31/2020
8. List ALL fishers’ full names and addresses, type of product, and weight of product obtained from each (attach
additional sheets of paper as necessary):
Name:
Address:
City:
State/Province:
County, Postal Code:
Total weight of product supplied:
Note: for questions 9, 10, 11, and 12, if you obtained product(s) from a supplier or dealer, you must
obtain, and supply to us, all of the required information from the supplier. All supporting
documentation must be submitted in an organized format; otherwise our review and processing time
will be greatly affected and we may be unable to authorize the permit(s). We request that
documentation is organized first by State of harvest (i.e., all documentation for fish harvested from a
particular state are clipped together). Within each State packet, the documentation should be grouped
by fisher (i.e., all invoices for a particular fisher are clipped together).
9. Provide a copy of the appropriate commercial buyer’s license(s).
10. For each fisher listed above, provide a copy of the current license(s), permit(s), or other documents issued by
the State or local wildlife authorities approving the commercial fishing activities.
11. Provide copies of each fisher’s State harvest report for the product(s) to be exported. The harvest report
should include, at a minimum, the following information. If any of this information is not listed on the fisher’s
harvest report, the information must be provided separately for each fisher on an attached sheet of paper and
signed by the fisher.
a.
Dates the fish were harvested;
b.
Harvest location(s), including the State, county(ies), body of water, AND the nearest mile marker or
boat ramp to each harvest location; and
c.
Gear used to harvest the fish.
12. Provide copies of documentation showing the transfer of ownership (e.g., dated sales receipts/invoices) of the
product from each fisher or supplier to you. If you received the product from a supplier(s) or source other
than the harvesters of the fish, provide documentation demonstrating the history of transactions (chain of
ownership of the product) from the fisher(s) to you. You must be able to provide documentation for EACH
change in ownership from the time of harvest until the time you purchased the product.
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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