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Massachusetts For-Hire Fishing License Application

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Massachusetts For-Hire Fishing License Application Powered By Docstoc
					                                            Division of Marine Fisheries
                                           251 Causeway Street, Suite 400                                                     Form DMF-RF2
                                                 Boston, MA 02114                                                 For-Hire Fishing
                                           www.mass.gov/marinefisheries                                        Permit Application Form


Instructions: This form may be used to apply for a Massachusetts For-Hire permit. Please provide all
requested information. Incomplete forms may result in the delay of permit issuance.

Section 1.
                                                         Applicant Information
Last Name:                                            First Name:                                        MI:             Suffix:

Date of Birth:                                        MA Resident:         Yes            No             US Citizen:      Yes      No

                                                          Residency Address
Street 1:

Street 2:

Zip code:                            City:                                                     State:
                                             Mailing Address (if different than above)
Street 1:

Street 2:

Zip code:                            City:                                                     State:

                                                      Other Information (*required)
*Phone #:                                                               Cell Phone:

e-mail address:

                                           Licensed Captain & Vessel Information
Vessel Name:                                                            Registration #:

Business Name:                                                          Operator Name:

Operator Phone:                                                         *U.S. Coast Guard License #:

Vessel Homeport:                                                        Vessel Length:

Do you want this vessel listed in the Saltwater Fishing Guide:                      Yes         No

If Yes, What Contact Phone Number do you want to list in the Guide? ___________________________________
   *A copy of a current U.S. Coast Guard License that authorizes the operator to carry passengers must be
                                       submitted with this application.

Section 2. Please select the type of permit you are applying for:

                      Charter Boat:                   MA Resident $65                             Non-Resident, $130


                      Head Boat:                      MA Resident, $130                           Non-Resident, $260

                         Checks can be made payable to: Commonwealth of Massachusetts


Section 3. Certification/Signatures

I certify under the pains and penalties of perjury that all information contained in the application is true and accurate
to the best of my knowledge and belief.

Applicant:
                           (Signature of applicant)                                                                Date
Parent or Guardian:
                           (Parental or Legal Guardian consent needed if child is under 17 years old).                 Date

				
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