Lobster Operator Permit Catastrophic Lost Trap Tag Affidavit

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This application is needed in the event of a catastrophic loss of 75 or more Lobster Operator Permit Trap Tags.

A brief description of the form or Application to be filled out here.

COMMERCIAL FISHING ID #
LOBSTER OPERATOR PERMIT #
GO ID NUMBER
Name
First Middle Last
Phone
Email
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
PHYSICAL ADDRESS (DO NOT USE PO BOX)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
COMPLETE THE FOLLOWING: A description of the events that resulted in the destruction or loss of trap tags and any other information that will help us assess the circumstances of the loss. Provide copies of documentation of any reports filed reporting the loss or destruction of trap tags.
Date the tags were first known to be lost or destroyed
MM slash DD slash YYYY
Last known latitude and longitude coordinates of traps/tags
Date traps were last serviced
MM slash DD slash YYYY
Describe if weather events, or other factors are the suspected causes of loss:
Number of Lobster Operator Permit Trap Tags to be replaced
Please enter a number from 0 to 300.
Trap tag Fees
# of tags x $1.25
Price: $0.00
Tags that were lost:
Please write in a comma separated list. Example: 1, 5, 25, 100, 205.
Contact Information
Name
First Last
Email*
Enter Email Confirm Email
Phone*
Application Fee
Price:
RENEWAL ADVANCED PAYMENT OPTION
- No Additional Years
- 2 year renewal
- 3 year renewal
- 4 year renewal
- 5 year renewal
Total
$0.00
Consent*
I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.
I agree
NAME:*
Type your full name to sign this secure webform
Signature*
CAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)
Date
MM slash DD slash YYYY
Authorization*
I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected permits. I understand that my application will be processed in the order in which it is received by Commercial Fishing Permits Center, a private fee-for-service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Commercial Fishing Permits Center's no refund policy. I understand that submitting another application for a license or permit will supersede the current/pending application for that license or permit. I understand that Commercial Fishing Permits Center does not issue or sell any licenses or permits.
I agree
Credit Card
Card Details
Cardholder Name
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BILLING ADDRESS
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
By clicking submit you agree to these Terms and Conditions and the above authorization of payment.

COMPLETE THE FOLLOWING: A description of the events that resulted in the destruction or loss of trap tags and any other information that will help us assess the circumstances of the loss. Provide copies of documentation of any reports filed reporting the loss or destruction of trap tags.

Contact Information