Cites Export License Form – Fill Out and Use This PDF

Form 3-200-26	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

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

1.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 amount of $100. 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 6

Form 3-200-26OMB Control No. 1018-0093 Expires 08/31/2020

E. COMMERCIAL EXPORT OF SKINS OF 6 NATIVE SPECIES: BOBCAT, RIVER OTTER, LYNX, ALASKAN BROWN BEAR,

ALASKAN GRAY WOLF, AND AMERICAN ALLIGATOR (CITES)

Note: This application should be used solely for the export of furs and skins in the commercial trade. Applications that are submitted to the Office of Law Enforcement (OLE) must be submitted to an OLE office in the region where the applicant is located. If the skin is from a sport-hunted trophy, please use Form 3-200-28 and submit the application to the Division of Management Authority (DMA).

Provide the following information. Complete all questions on the application. Mark questions that are not applicable with "N/A". If needed, use a separate sheet of paper. On all attachments or separate sheets you submit, indicate the application question number you are addressing.

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, please either include a disk containing your information or, 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 athe 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?

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.

Rev. 8/2017

Page 2 of 6

Alligator	American
mississippiensis	alligator
Ursus arctos	Alaskan brown
	bear
Canis lupus	Alaskan gray
	wolf

5.Skins of these native species must be tagged with a CITES Tag at the time of export or re-export. Please see 50§ 23.69(c) and 23.70(d) for CITES tagging requirements. Provide a complete list of the CITES tag numbers (e.g. FL MIS 0712345 - always refer to tag) or CITES replacement tag numbers (e.g. FWS REPL 0123456 – always refer to tag). NOTE: Tags must be inserted through the skins and permanently locked in place at the time of export. Replacement tags must be obtained before submitting your application (broken tags must be surrendered at the time of requesting replacement tags).

6.Applicants residing or located outside the United States conducting commercial activities. The name, physical address and telephone number of your agent who is located in the United States and will maintain your records for five (5) years from the expiration of the permit. If the location is the same as in item 3, then indicate “same as 3." (This information is required under 50 CFR 13.12 and 13.46).

U.S. address (not a P.O. Box) for foreign applicant. (This information is required under 50 CFR 13.12).

Name:

Business Name:

Address:

Address:

City:

State/Province:

Country, Postal Code:

7.Provide the name and address of the recipient in the foreign country (if it is yourself, provide your foreign address).

Name:

Business Name:

Address:

Address:

City:

State/Province:

Country, Postal Code:

Rev. 8/2017

Page 3 of 6

Form 3-200-26	OMB Control No. 1018-0093
	Expires 08/31/2020

8.Current location of skins (Street Address, City, State/Province, County, Postal Code):

9.Provide a copy of your valid Import/Export License.

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

Page 4 of 6

Form 3-200-26	OMB Control No. 1018-0093
	Expires 08/31/2020

APPLICATION FORM INSTRUCTIONS

The following instructions pertain to U.S. Fish and Wildlife Service (FWS) permit applications. The General Permit Procedures in 50 CFR 13 address the permitting process. For simplicity, all licenses, permits, registrations, and certificates are referred to as a permit.

GENERAL INSTRUCTIONS:

•Complete all relevant questions in Sections A or B, C, D, and E.

•An incomplete application may cause delays in processing or may be returned to the applicant. Be sure you are filling in the appropriate application form for the proposed activity.

•Print clearly or type in the information. Illegible applications may cause delays.

•Sign the application. Faxes or copies of the original signature will not be accepted.

•Mail the original application to the address at the top of page one of the application or, if applicable, on the attached address list.

•Keep a copy of your completed application.

•Please plan ahead. Allow at least 60 days for your application to be processed, however, some applications may take longer than 90 days to process (50 CFR 13.11).

•Applications are processed in the order they are received.

SECTION A OR SECTION B:

Section A. Complete if applying as an individual [do not complete if importing/exporting under an Import/Export License.]:

•Enter the complete name of the responsible individual who will be the permittee if a permit is issued. Enter personal information that identifies the applicant. Fax and e-mail, while helpful in processing, are not required.

•If you are applying on behalf of a client, the personal information must pertain to the client, and a document evidencing power of attorney must be included with the application.

•Affiliation/ Doing business as (dba): business, agency, Tribe, organizational, or institutional affiliation directly related to the activity requested in the application (e.g., a taxidermist is an individual whose business can directly relate to the requested activity). The Division of Management Authority (DMA) and the Office of Law Enforcement (OLE) do not accept doing business as affiliations for individuals (complete Section B).

Section B. Complete if applying as a business, corporation, public agency, Tribe, or institution:

•Enter the complete name of the business, agency, or institution that will be the permittee if a permit is issued. Give a brief description of the type of business the applicant is engaged in. Provide contact phone number(s) of the business. If you are applying on behalf of a client, a document evidencing power of attorney must be included with the application.

•Principal Officer is the person in charge of the listed business, corporation, public agency, Tribe, or institution. The principal officer is the person responsible for the application and any permitted activities. Often the principal officer is a Director or President. Primary Contact is the person at the business, corporation, public agency, or institution who will be available to answer questions about the application or permitted activities. Often this is the preparer of the application.

ALL APPLICANTS COMPLETE SECTION C:

•For all applications submitted to the Division of Management Authority (DMA), a physical U.S. address is required.

•Mailing address is the address to which communications from USFWS should be mailed if different from applicant’s physical address.

ALL APPLICANTS COMPLETE SECTION D:

Section D.1 Application processing fee:

•An application processing fee is required at the time of application, unless exempted under 50 CFR13. The application processing fee is assessed to partially cover the cost of processing a request. The fee does not guarantee the issuance of a permit, nor will fees be refunded for applications for which processing has begun.

•Documentation of fee exempt status is not required for applications submitted by Federal, Tribal, State, or local government agencies; but must be supplied by those applicants acting on behalf of such agencies. Such applications must include a letter on agency letterhead and signed by the head of the unit of government for which the applicant is acting on behalf, confirming that the applicant will be carrying out the permitted activity for the agency.

Section D.2 CERTIFICATION:

•The individual identified in Section A, the principal officer named in Section B, or person with a valid power of attorney (documentation must be included in the application) must sign and date the application. This signature legally binds the applicant to the statement of certification. You are certifying that you have read and understand the regulations that apply to the permit. You are also certifying that all information included in the application is true to the best of your knowledge. Be sure to read the statement and re- read the application and your answers before signing.

ALL APPLICANTS COMPLETE SECTION E

Please continue to next page. DO NOT RETURN THIS PAGE WITH THE APPLICATION

Rev. 8/2017

Page 5 of 6

Form 3-200-26	OMB Control No. 1018-0093
	Expires 08/31/2020

NOTICES

Privacy Act Statement

Authority: The information requested is authorized by the following: the Bald and Golden Eagle Protection Act (16 U.S.C. 668), 50 CFR 22; the Endangered Species Act (16 U.S.C. 1531-1544), 50 CFR 17; the Migratory Bird Treaty Act (16 U.S.C. 703-712), 50 CFR 21; the Marine Mammal Protection Act (16 U.S.C. 1361, et seq.), 50 CFR 18; the Wild Bird Conservation Act (16 U.S.C. 4901-4916), 50 CFR 15; the Lacey Act: Injurious Wildlife (18 U.S.C. 42), 50 CFR 16; Convention on International Trade in Endangered Species of Wild Fauna and Flora (TIAS 8249), 50 CFR 23; General Provisions, 50 CFR 10; General Permit Procedures, 50 CFR 13; and Wildlife Provisions (Import/export/transport), 50 CFR 14.

Purpose: The collection of contact information is to verify the individual has an eligible permit to conduct activities which affect protected species. This helps FWS monitor and report on protected species and assess the impact of permitted activities on the conservation and management of species and their habitats.

Routine Uses: The collected information may be used to verify an applicant’s eligibility for a permit to conduct activities with protected wildlife; to provide the public and the permittees with permit related information; to monitor activities under a permit; to analyze data and produce reports to monitor the use of protected wildlife; to assess the impact of permitted activities on the conservation and management of protected species and their habitats; and to evaluate the effectiveness of the permit programs. More information about routine uses can be found in the System of Records Notice, Permits System, FWS-21.

Disclosure: The information requested in this form is voluntary. However, submission of requested information is required to process applications for permits authorized under the listed authorities. Failure to provide the requested information may be sufficient cause for the U.S. Fish & Wildlife Service to deny the request.

PAPERWORK REDUCTION ACT STATEMENT

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) in order provide the U.S. Fish and Wildlife Service the information necessary, under the applicable laws governing the requested activity, for which a permit is requested. Information requested in this form is purely voluntary. However, submission of requested information is required in order to process applications for permits authorized under the applicable laws. Failure to provide all requested information may be sufficient cause for the U.S. Fish and Wildlife Service to deny the request. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1018-0093.

ESTIMATED BURDEN STATEMENT

Public reporting for this collection of information varies depending on the activity for which a permit is requested. The relevant burden for FWS Form 3-200-26 is 20 minutes including time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: BPHC, Falls Church, VA 22041-3803. Please do not send your completed application to this address.

Rev. 8/2017

Page 6 of 6