COMMERCIAL MARINE FISHERIES INDIVIDUAL LICENSE ... - Hawaii

COMMERCIAL MARINE FISHERIES INDIVIDUAL LICENSE/PERMIT RENEWAL APPLICATION FORM

* Complete this Form

* Review and Sign the General Fisheries License & Permit and Specific Terms and Conditions (reverse side).

* Write your license number on check or money order payable to: Division of Aquatic Resources .

* If you are interested in obtaining a new license type, contact the DAR office listed on the attached cover letter.

* Please send payment and form to:

Check License/Permit types (s) that you intend to renew:

DIVISION OF AQUATIC RESOURCES

ATTN: STATS UNIT/Licensing

1151 Punchbowl St. RM 330

Honolulu, HI 96813

Commercial Marine License

Bait License

PLEASE TYPE OR PRINT INFORMATION CLEARLY:

Fishing License No.

M/F

Sex

Last Name

--

Y/N

--

Social Security Number

/

First Name

Y/N

U.S. Citizen

HI Resident

Alien Number

ft.

/

Date of Birth (MM/DD/YY)

Birth Place

Middle Name

in.

Height

ID Number

ID Type

lbs

Weight

Hair Color

Eye Color

Residence Address

City

State

ZIP Code

Country

Mailing Address

City

State

ZIP Code

Country

Cell Phone

Home Phone

Business Phone

E-mail Address

VESSEL INFORMATION

Y/N

Captain

Y/N

Crew

Y/N

Number of Crew

Charter

Y/N

Required to Report?

Full Time

Paper Report given/mailed?

Vessel Name

Captain's Name

HA HA - No.

USCG No.

Vessel Owner

Home Port

Fishing Gear/Method (in order of preference):

1

2

3

Do you intend to file your

Fishing Report online?

efile?

Y / N

please circle one

Do you intend to peddle any of

your catch to friends, neighbors,

on the street/rd,or online sales?

Y / N

non dealer

please circle one

TURN OVER FORM TO REVIEW AND SIGN COMMERCIAL FISHERIES LICENSE & PERMIT GENERAL TERMS AND

CONDITIONS.

Rev Jan. 13, 2021

Department of Land and Natural Resources (DLNR)

Division of Aquatic Resources

CML Number _____________

State of Hawaii

Commercial License & Permit

General Terms and Conditions

Licensee Name ___________________

These general terms and conditions apply to all licenses and permits, herein after referred to as

¡°licenses¡± contained in Chapter 13-74, Hawaii Administrative Rules (HAR) of DLNR.

I understand that

1.

I must provide true, complete and accurate information on any license application, or any

report that I am required to submit.

2.

I am responsible for renewing my license even without notification from DLNR. Unless

some other expiration period is specified, licenses are valid no longer than one year from

the issuance date.

3.

Upon request, I must present my license to any officer authorized to enforce State laws.

4.

I must allow my catch to be inspected by any officer authorized to enforce State laws.

5.

The State, or its agents, shall not be liable for any personal injury, death or property

damage resulting from any action or activity authorized by this license.

6.

DLNR may suspend my license when such action is necessary for the protection and

conservation of marine life.

7.

The Board of Land and Natural Resources may revoke any license. I may not renew a

revoked license or permit for one year from the date of revocation.

8.

DLNR may refuse to issue any or all licenses if I do not comply with the terms and

conditions of this or any other license

Terms and Conditions:

I understand and agree to abide by all general terms and conditions of the license as specified in the

General Terms and Conditions, on applicable Specific Terms and Conditions forms, and as may be

provided elsewhere by law. I understand that any violation of any term or condition of this license,

including any misstatement of fact or circumstance, may result in the invalidation and/or revocation of

this license, and the prosecution of an enforcement action against me as specified in the Hawaii Revised

Statutes, Chapters 187A, 188, and 189. In the event of any difference between the terms and conditions

of this license, as stated above, and the applicable administrative rules or law, the rules and law shall

apply.

My electronic signature shall be considered as my agreement to comply with all requirements and

may be recorded electronically through the Internet licensing application. This procedure is deemed

lawful under the Uniform Electronic Transactions Act, Section 489E, Hawaii Revised Statutes.

Signature: ________________________________________ Date: _____________________

Signature is required to renew license/permit, otherwise, the application will be returned.

DAR, DLNR Copy (mail in to Division of Aquatic Resources)

Rev Jan. 13, 2021

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