Application Form for Issuable Permits Home » North Carolina » Application Form for Issuable Permits Dealer Permit for Monitoring Fisheries under a Quota A brief description of the form or Application to be filled out here. Vessel Name Vessel Use / Endorsement Pleasure Commercial Official Number Confirm Official Number Select One: Individual (complete the Individual Participant Information below) Business Agent (complete the Business Participant AND Individual Participant Information below) Individual Participant InformationName First Middle Last Suffix Date of Birth MM slash DD slash YYYY Business Agent InformationBusiness Name Business Agent Name (First, MI, Last) Participant ID PERMIT CATEGORIESStriped Bass Dealer PermitCurrent Permit # New Renew Update Replace Atlantic Ocean ASMA Central/Southern Area Contact Person (First, MI, Last) Date of Birth MM slash DD slash YYYY Contact Person Telephone #Dealer # Dealer # Dealer # Atlantic Ocean Flounder Dealer PermitCurrent Permit # New Renew Update Replace Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Dealer # Dealer # Dealer # Spiny Dogfish Dealer PermitCurrent Permit # New Renew Update Replace Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Dealer # Dealer # Dealer # Black Sea Bass – North of Cape Hatteras Dealer PermitCurrent Permit # New Renew Update Replace Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Dealer # Dealer # Dealer # Blue Crab Shedding PermitCurrent Permit # New Renew Update Replace Number of Tanks or Floats by System:Closed Recirculating Flow-through Floating Other If other, please describe the system Peelers obtained by:Catches Own Purchases from Others Both Facility Location: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Estuarine Gill Net Permit (EGNP)For Renewals-Current Permit # New Renew Update Replace Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Vessel ID, Registration or DocSCFL, RSCF L or RCGL #Management Areas Fished A B C D1 D2 E Refer to map, circle all that applyGill Net Mesh Size Fished: <=4" Gill Net Mesh Size Fished: >4" Gill Net Mesh Size Fished: All Horseshoe Crab Biomedical Use PermitCurrent Permit # Report filed by February 1 Yes No New Renew Update Replace Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Permit to Waive the Requirement to Use TEDs in Atlantic OceanCurrent Permit # New Renew Update Replace Vessel Name Vessel I.D. (P Number) Vessel USCG Number Vessel USCG Number Trawl – Total Headrope Length (Ft.) Number (Rigs) Single (1), Double (2), Twin (4)SCFL, RSCFL or Assignment No. Monkfish Large Mesh Gill Net PermitCurrent Permit # New Renew Update Replace Contact Person (First, MI, Last) Contact Person Date of Birth MM slash DD slash YYYY Contact Person Telephone #Vessel I.D. (P Number) SCFL or RSCFL License No. Crew Member #1 (First, MI, Last): Date of Birth MM slash DD slash YYYY Phone #Crew Member #2 (First, MI, Last): Date of Birth MM slash DD slash YYYY Phone #Crew Member #3 (First, MI, Last): Date of Birth MM slash DD slash YYYY Phone #I ____ certify that 1. All the information provided on this application and any supporting documentation provided is true, accurate, and complete. And further, for renewals, any changes in information or supporting documents have been provided at the time of renewal. I understand that any false information or fraudulent disclosures may result in termination of appropriate licenses, permits and related documents, revocation or suspension of marine fisheries licensing and other privileges, and in possible criminal prosecution. 2. I am a resident of the State of: If claiming resident status in North Carolina, I certify further that (check one): I have been a legal resident for more than six months, or If domiciled in North Carolina between 60 days and six months, I have completed and submitted with this application a notarized Certificate of Eligibility for North Carolina Residency. 3. If applying for a Standard or Retired Standard Commercial Fishing License as a North Carolina Resident, I also certify that:(initial the appropriate entry)I filed a North Carolina State Income Tax Return for the previous calendar or tax year. Please initialI was not required to file a North Carolina State Income Tax Return for the previous calendar or tax year. Please initialApplication 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 agreeI 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.NAME: Type your full name to sign this secure webformSignatureCAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER) Date MM slash DD slash YYYY Authorization I agreeI 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.Credit Card Having Trouble with your card? My card information is not workingCheck this box to move forward without your Credit Card.By clicking submit you agree to these Terms and Conditions and the above authorization of payment.
