Fillable Vessel Permit Application (State of Connecticut/Department of Administrative Services)

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Vessel Permit Application (State of Connecticut/Department of Administrative Services)

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The Vessel Permit Application (State of Connecticut/Department of Administrative Services) form is 2 pages long and contains:

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  • 2 check-boxes
  • 90 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of Connecticut/Department of Administrative Services

BROWSE STATE OF CONNECTICUT/DEPARTMENT OF ADMINISTRATIVE SERVICES (CT) FORMS

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OFFICE USE ONLY
Check No___________________
Check Amount______________
Date Issued_________________
Conservation ID (if known)
First Name Last NameMI
Birthday
Height
Gender
Weight
Hair ColorEye Color
Ethnicity
Vessel Permit Application
Rev 12/2015
State Number
Drivers License Information
Daytime Phone Number Evening Phone Number
Contact Information
Email Address
Residence Address
City State Zip Code
Mailing Address (if different than residence)
Black
White Hispanic
Asian
Native
American
Other
Male Female
Zip CodeStateCity
New License Renewal
For License Year
Mail to: Department of Energy and Environmental Protection
License and Revenue Unit, 79 Elm St., Hartford, CT 06106
Continue on reverse side
Primary Vessel Owner Information
Passenger CapacityCrew Size
Net TonnageGross Tonnage
Vessel Secondary ColorVessel Primary Color
(Inches)Depth (feet)(Inches)Beam (feet)
(Inches)Vessel Length
(feet)
Hull Material
Propulsion Type (ex: Gas, Diesel)Connecticut Landing Port
Home PortHome Port State
Year BuiltVessel Type (ex: Party, Charter, Lobster, Trawler, Open, Cabin)
Federal Permit NumberUSCG Doc Number
State Registration NumberVessel Name
Vessel Identification Information
Vessel Purchase Date
Commercial Fishing Vessel Permit............................$100.00
For use of a vessel for activities authorized under any commercial fishing,
finfish, lobster or landing license.
What is your home port town?
Marina name (or) exact location?
Passenger capacity?
Date of issue?
Coast Guard Reference Number?
Who is the principal operator?
Party / Charter Vessel Registration...........................$315.00
To operate a party / charter boat or for-hire recreational vessel to take marine
species in Connecticut waters or land marine species at Connecticut ports,
regardless of where those species are taken. A separate party / charter
registration is required for each vessel operated for this purpose.
For Hire
Permit Selection
Commercial
By signing this application, I agree that at any time and without delay, I shall permit any law enforcement officer to board any of my vessels and enter upon my
premises to inspect the catch, nets, traps, and other devices used for taking or holding finfish, lobsters, crabs, squid, whelk, bait species or sea scallops to
determine compliance with Title 26 of the General Statutes, as amended. I understand that any person making a written false statement on this form shall be
subject to arrest as provided for in Sec. 53a-157b of the General Statutes as amended. I declare that my right to obtain the license or registration applied for is
not void or under suspension.
Company and Title (if applicable)Signed (Owner)
Total Fee
Make check / money orders payable to Department of Energy and Environmental Protection.
Conservation ID (if known)
First Name Last Name
Birthday Eye Color Hair Color
State Number
Contact Information
Daytime Phone Number Evening Phone Number Email Address
Residence Address Mailing Address (if different than residence)
City State Zip Code City State Zip Code
Weight
FemaleMale
Secondary Vessel Owner Information (If applicable)
MI
Drivers License Information
Gender
Height
White
Asian
Hispanic
Black
Native
American
Other
Ethnicity
Date
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Vessel Permit Application (State of ConnecticutDepartment of Administrative Services)

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Completed 13 August 2020

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