Estuarine Gill Net Permit Application - Commercial Fishing Permits Center

Vessel Name

Vessel Use / Endorsement

Pleasure
Commercial

Official Number

Confirm Official Number

Applicant Information

Participant I.D. if available

Commercial License No. (if applicable)

Name

First Middle Last Suffix

Date of Birth

Please provide one

Driver’s License No.	Or State I.D. No.	Or Military I.D. No.	Or Resident Alien I.D.	Or Passport No.

Expiration date the number above

Race:

Gender

Height

Weight

Eye Color

Hair Color

Email

Enter Email Confirm Email

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Business Phone

Fax

Cellular Phone

Estuarine Gill Net Permit Application Information

Primary contact phone number where you can be reached:

Commercial Use of Gill Nets (check box)

must have a valid Standard Commercial Fishing License or Retired SCFL

P-Number Vessel	Length:

Recreational Use of Gill Nets (check box)

must have a valid Standard Commercial Fishing License or Retired SCFL

Vessel Length

Management Units Fished (A,B,C,D1,D2,E) Refer to attached map

1st most frequent	2nd most frequent	3rd most frequent	4th most frequent	5th most frequent	6th most frequent

Gill Net Mesh Size Fished

<=4” (small mesh)
>4” (large mesh)
Both

Certification Statement (This section must be completed by Applicant)

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 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:

I filed a North Carolina State Income Tax Return for the previous calendar or tax year.

Please initial

I was not required to file a North Carolina State Income Tax Return for the previous calendar or tax year

Please initial

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 agree

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.

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

Authorization

I agree

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.

Credit Card

Card Details

Cardholder Name

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