FWS Form 3-200-85 "Permit Application Form: Establishment of a Master File for the Export of Live Animals Bred in Captivity Under Cites (Multiple Commercial Shipments)"

What Is FWS Form 3-200-85?

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 3-200-85 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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Form 3-200-85
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
ESTABLISHMENT OF A MASTER FILE FOR THE EXPORT OF LIVE
Branch of Permits, MS: IA
ANIMALS BRED-IN-CAPTIVITY under the Convention on International
5275 Leesburg Pike
Falls Church, VA 22041-3803
Trade in Endangered Species (CITES) (Multiple Commercial Shipments)
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. 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 11
Form 3-200-85
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
ESTABLISHMENT OF A MASTER FILE FOR THE EXPORT OF LIVE
Branch of Permits, MS: IA
ANIMALS BRED-IN-CAPTIVITY under the Convention on International
5275 Leesburg Pike
Falls Church, VA 22041-3803
Trade in Endangered Species (CITES) (Multiple Commercial Shipments)
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. 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 11
Form 3-200-85
OMB Control No. 1018-0093
Expires 08/31/2020
E. ESTABLISHMENT OF A MASTER FILE FOR THE EXPORT OF LIVE ANIMALS BRED IN CAPTIVITY IN
THE UNITED STATES (CITES)
This application allows you set up a Master File for exports of live animals bred in captivity under CITES. The
Master File is valid for three years and is renewable. Once the Master File is approved you must obtain single-
use permits, valid for 6 months, for each export (50 CFR 13.11).
Note 1: Species that are listed on pages 5 and 6 of this application are currently eligible for inclusion in a
master file. This list contains species where it has been determined that specimens were born or hatched from
parents mated in captivity in the United States qualify as Bred-in-Captivity in accordance with CITES
Resolution Conf. 10.16 (Rev.) and are therefore eligible for issuance of certificates under the provisions of
CITES Article VII, paragraph 5. If a species you are interested in including on a master file is not listed, you
may either submit application form 3-200-24 or complete questions 6 through 10 of this application to request
that specimens produced at your facility be considered Bred-in-Captivity. If it is determined that your
specimens do not meet the criteria under Resolution Conf. 10.16 (Rev.), you may still be eligible to obtain
individual export permits for the specimens.
Note 2: We may not be able to issue CITES documents for the commercial export of Appendix-I specimens,
unless the specimens were produced at a commercial breeding operation that is registered with CITES
Secretariat. For more information on registering commercial breeding operation for Appendix-I wildlife, contact
the Division of Management Authority at 800-358-2104 or managementauthority@fws.gov.
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 acknowledgement letter, e-mail your information to Permits@fws.gov. Be sure to include the
application number provided in the acknowledgement e-mail that will be sent to you when we receive your application.
I will be submitting documents electronically.
I would like to:
ESTABLISH A NEW MASTER FILE (Processing Fee = $200)
(This application allows you set up a Master File, valid for 1 to 3 years, and renewable, for exports of
certain species under CITES. Once the Master File is approved, you will need to obtain single-use
permits, valid for 6 months, for each export (50 CFR 13.11))
RENEW AND/OR AMEND AN EXISTING MASTER FILE, # _________ (Processing Fee = $100)
How many single-use permits do you anticipate using in the next 6 months? ______________
Provide $5 for each 6-month permit. Additional permits may be requested by submitting
form
3-200-74.
Please respond to each of the following questions and provide all information requested. Mark items that are
not applicable with “N/A”. If needed, use separate sheets of paper. Please indicate the question/item number
you are addressing on all attachments or separate sheets you submit. If you are applying for multiple species,
be sure to indicate which species you are addressing in each response.
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)?
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Form 3-200-85
OMB Control No. 1018-0093
Expires 08/31/2020
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.
4. For EACH wildlife species to be shipped, provide the following information:
a.
Scientific name (genus, species, and, if applicable, subspecies);
b.
Common name;
c.
Typical description of specimens to be exported (e.g., hatchlings, sub-adults; typical size);
d.
Estimated annual production of specimens;
e.
Estimated annual export of specimens; and
f.
Normal mortality rates at your facility.
5. Where are the specimens currently located? (e.g., physical address of facility including county).
Name:
Street Address:
City/Province:
State:
Country, Postal Code:
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Form 3-200-85
OMB Control No. 1018-0093
Expires 08/31/2020
6. As the breeder, sign (in ink) the following statement:
I hereby certify that the species listed above to be exported were bred and born/hatched from parental stock
at my facility listed below. (Additional information on the parental stock may be requested upon receipt of
your application).
a.
Name and address of your facility where the animals were bred and born/hatched:
b.
Name of facility/operation:
c.
Street Address:
d.
City, State, Zip Code:
e.
Current location of parental stock:
f.
Street Address:
g.
City, State, Zip Code:
Signature _____________________________________________ Date __________________
7. If you are NOT the breeder of the specimen(s), provide copies of documentation showing that you acquired
the Animal(s) from the breeder or documentation demonstrating the history of transactions (chain of
ownership of each animal) and a signed statement from the breeder or breeder's record that includes:
a.
That the animal was bred and born/hatched at his/her facility;
b.
Birth/hatch date, and, if applicable, band/tag number, or other identifiers;
c.
Sex of each specimen he/she bred;
d.
Location (name, street address, city, state) of parental stock;
e.
Complete name and address of the breeder's facility.
8. Provide labeled photographs depicting the facilities for the specimens described in your application.
9. If the species you intend to export appears on the attached list, skip questions 11–15.
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Form 3-200-85
OMB Control No. 1018-0093
Expires 08/31/2020
10. For species that are NOT included on the attached list: As stated above, in order to establish a master
file, the species being proposed for export must be on the attached list (see SPECIES THAT QUALIFY AS
CAPTIVE-BRED). For species that are NOT included on the attached list, you can request that the species
be approved for your facility by completing the questions 11-15 (this may be attached on separate paper or
submitted in a table or as a spreadsheet):
11. Provide information about the breeding facility, including:
a.
Property size;
b.
Size and type of facility buildings (such as, food prep room and incubation facilities);
c.
Size and type of cage or enclosure used to house juveniles, adults, hatchlings, as appropriate;
d.
Are the cages or enclosures indoors or outdoors?,
e.
How many cages and enclosures does the facility provide?;
f.
How is the location secured (i.e., fence, guard dog, electric wire, etc.) from both theft and natural
disaster?
g.
How are animals uniquely identified (pit tags, leg bands, notching, photos)?
12. Provide documentation that demonstrates that the founder stock was legally obtained in accordance to CITES
and with foreign, State and local laws (all original stock used to produce the offspring even if now dead or no
longer able to breed). Examples of documentation include CITES Permits, State Collecting Permits, receipts,
or letters of affidavit from original breeder on how they obtained these animal, and receipts showing the chain
of custody.
13. Provide any available documentation that the breeding stock was acquired in a manner that was not
detrimental to the species. Examples of documentation include information on status of the species in the
wild; the availability of the species in the domestic and international trade; and the ease/difficulty of breeding
the species in captivity.
Rev. 8/2017
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