OMB No 1011-0093 Department of the Interior Expirn O>IJ lllO 17 U.S. Fish and Wildlife Service Federal Fish and Wildlife Permit Application Form
Rc:tum to: Division ofM~~nagcmcntAuthority (DMA) Type of Attivlty: U.S. fish ll!ld Wildlire Service CAPTIVE·BRED WILDLIFE REGISTRATION (CBW) 4401 N. fairfax Drive, Room 212 (U.S. Endangered Species Act) Arlington, VA 22203 QNew Application 1-800.358·21 04 or 703·358·21 04 t=JUqucsting RCJiewai/Amcndment of PermilN ----- Complete Sections A orB, and C, 0, and E or this application. U.S. address may be required in Section C, see instn1ctions for details.
Sec altadu:d instruction p~~~:esfor information on how Jo make your application complete and help avoid unnecessary delays. A. Co•plete if applying as an Individual l.11.l..:1Stname l.b. First name I.e. Middle name or Initial J.d. Suffix
2. Date or birth (mm/ddlyyyy) 3. Social Security No. 4. Occupauon S. Affiliation/ Doing business as (see instructions)
6.a. Telephone number 6.b. Alii: male telephone number 6.c:. Fu number 6.d. E-nwl addR:s.s
D. All &DPUcantsMUST complete I. Attacll chedc Of money order payable 10the U.S. FISH AND WILDLIFESERVICE IIIIMamouncerSlot oonrefundable fte. Federal, Tribal. State, and looll
govel'lll!lefttagencies. 111\dthose acting on behalf of sucb ag~mcies.are exempt from lbc processing fee- llltllcb dtn:IIIPUllftlllfDII11//te e:umpt stlllflll CIS1111tlbrN In lnstnlcti01ts. (SOCFR 13.11(d)) 2. Do yo~tly have or fuM: you ever had any Federal Fish and Wildlife permits? Yes (yes, lise the numbcroflhe most cwrent pennit you have lu:td oc lh:it you are applying 10renc:wfre.issiiC: L..E'"B42~ I ~A.-.fJJ NoD 3. Ccrtilicalion: I hcn:by cat if)' lhllcl have n:ad and Dill filntiliar with the rqularions 'ontuned in Tltk 50, Ptn113 of rAe Colle of Ftdt!l'fll Rtgalatlotts and the olhcr yplkahle~ill Sllbclfylu B P/Cimpttr I of Tille 58.nnd I cenify that the infornmtion submined in this application for a pcnnicls complcle and accunue 10 lbe bestof my . •ledge and bclicw lh:u any false suucmcnlbcrcin may subjccl me 10 lbc criminal pc:nalticsor 18 % 1001.
l~i~~ "'-L' ~~ '? h :JruS' Sigiiiltun:( In iil\ie Ink) of otpphc:llllfpersonresponsible for permit (No photocopied or stamped signa1urcs) Date or s1~tltte(mmlddfyyyy)
3-200-41 Rev. 0212014 Please continue on next page Page 1 of6
Owner Owner
Sincerely, Sincerely,
Serpentarium Serpentarium
crocodilian crocodilian
us. us.
plenty plenty
documentation documentation endangered endangered
acquisition acquisition
Shoemaker, Shoemaker,
Please Please
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breeding breeding Dear Dear
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reviewing reviewing
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Branch Branch
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most most
Permits, Permits,
free free
for for
programs. programs.
Madam, Madam,
Management Management
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reptiles, reptiles,
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sale sale
2015 2015
possible. possible.
in in
Magic Magic
CBW CBW
VA VA
Wildlife Wildlife
to to
application application
future future
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22041-3803 22041-3803
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From From
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breeders, breeders,
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Part l: New Applications or the Renewal of CBW that are older than 10 years: Provide the following information. Complete all questions on the application. Signify that you have read each question by writing ~N/A" if non applicable. If needed, use separate sheets of paper. On all attachments or separate sheets you submit, indicate the application question number you are addressing.
1. The scientific name (genus, species and, if applicable, subspecies) and common name of each species you are seeking to have covered by the registration.
This application seeks to have CB W coverage for the following species:
COMMON NAME LATIN NAME
Radiated tortoise Astrochelevs radiala Cuban rock iguana Cvclura nuhilis nuhi/is Grand Cayman iguana Cvclura nuhilis lewisii Cayman Brae ground iguana Cvclura m1bilis cavmanensus San Esteban Island chuckwalla Sauroma/us varius Jamaican boa Epicrates suMlavus Indian python Python molurus molurus Aruba Island rattlesnake Crotalus unicolor
2. The exact location (address) where the wildlife requested in this application will be maintained. If more than one location exists, list all that apply. NOTE: You must report any change in address to the Division ofManagement Authority within 10 days.
All wildlife obtained under the terms of this CBW will be maintained at the facilities of:
3. The name, address, and CBW registration number of the person(s) or institution(s) from whom you plan to acquire the wildlife.
No sources have been formally identified to date because no CBW holders will make finn transactions until our penn it is issued. Regardless, the applicant has discussed acquiring Aruba Island rattlesnakes CBW-holder Phoenix Herpetological Society.
4. Provide a current inventory, including those out on lonn, of the ESA-Iistcd species you are requesting to include in a CBW registration.
None.
Not Not
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goals goals other other
of of
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data data
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documentation documentation
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West West
Pygmy Pygmy
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Coronado Coronado
Rattlesnakes Rattlesnakes Guarico
Mexican Mexican
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Mangshan Mangshan
Ethiopian Ethiopian South South
Mexican Mexican
Monocle Monocle Venezuelan Venezuelan
Jumping Jumping
Two Two
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Namblan Namblan
Ornate Ornate Patternless Patternless
Wetars Wetars Viper
Red Red
Striped Striped Broadband Broadband
Zebra Zebra
Cape Cape
Puff Puff
Northern Northern
Sir Sir
Horned Horned Osage Osage
Southern Southern
Dusky Dusky
Trans Trans
Baja Baja
Leudstlc Leudstlc
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Russe41s Russe41s
Eyelash Eyelash
Arrican Arrican
West West
Scaletess Scaletess
Blackheaded Blackheaded Gold Gold Okeetee Okeetee
Albino Albino
Scaletess Scaletess
King King Albino Albino
Indian Indian
Everglades Everglades
Flat-nose Flat-nose
Lankin Lankin
Spitting Spitting
Adder Adder Headed Headed
Cobra Cobra
Rattlesnake Rattlesnake
Lanceheads Lanceheads
African African
Cobras Cobras
Pecos Pecos
American American
Pygmy Pygmy
Spitting Spitting
Coppemead Coppemead
Spitting Spitting
Cobra Cobra
Eastern Eastern
Cantil Cantil
European European
Cottonmouth Cottonmouth
Bush Bush
Sand Sand
Viper Viper
VIpers VIpers
Pygmy Pygmy
Bl11cktail Bl11cktail
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Cobra Cobra
Pygmy Pygmy
VIpers VIpers
Com Com
Coral Coral
Texas Texas
Copperhead Copperhead
Eastern Eastern Copperhead Copperhead
Okeetee Okeetee
Mtn Mtn
Island Island
Vipers Vipers
Palm Palm
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rattlesnake rattlesnake
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Corn Corn
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Bushmaster Bushmaster
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Gaboon Gaboon
Rattlesnake Rattlesnake
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Viper Viper
Ratsnal Rattlesnake Rattlesnake Rattlesnake Rattlesnake (rlmeresurus (rlmeresurus (Prot.obothrops (Prot.obothrops arietans) arietans) (Crotalus (Crotalus (B.columbiensis) (B.columbiensis) Hoanose Hoanose Asp Asp Rattlesnake Rattlesnake Snake Snake Corn Corn (Atheris (Atheris ntvea) ntvea) (Vipera (Vipera (Naja (Naja (Agkistrodon (Agkistrodon naja) naja) (Bitis (Bitis (Elaphe (Elaphe (Naja (Naja kaouthla) kaouthla) VIper VIper (Agkistrodon (Agkistrodon (Crotalus (Crotalus (Naja (Naja (Viper (Viper (Agkistrodon (Agkistrodon (Trimeresurus (Trimeresurus (Agkistrodon (Agkistrodon (Agkistrodon (Agkistrodon Scaleless Scaleless (Aspldelaps (Aspldelaps r. r. (Agkistrodon (Agkistrodon Snake Snake platlrhlnos) platlrhlnos) (Heterodon (Crotalus (Crotalus (Agkistrodon (Agkistrodon (Eiaphe (Eiaphe (Agkistrodon (Agkistrodon pallida) pallida) (Lachesis (Lachesis hannah) hannah) (Agklstrodon (Agklstrodon (flaphe (flaphe (Sistrurus (Sistrurus russelll) russelll) nummlfer) nummlfer) parvioculas) parvioculas) (Crotalus (Crotalus (Heterodon (Heterodon schlegelii) schlegelii) ammodytes) ammodytes) e.enyo) e.enyo) nigricotlis) nigricotlis) (Bitls (Bitls squamigera) squamigera) samarensis) samarensis) a a albolabris) albolabris) (Crotalus (Crotalus (Sistrurus (Sistrurus bilineatus bilineatus (Crotalus (Crotalus (Crotalus (Crotalus guttata) guttata) punlceus) punlceus) aspis) aspis) (Elaphe (Elaphe (Crotalus (Crotalus d.pifanorum) d.pifanorum) (Eiaphe (Eiaphe contortrix contortrix mangshanensis) mangshanensis) guttata) guttata) gabonlca gabonlca obsoleta obsoleta d. d. lubrlcus lubrlcus p. p. taylori) taylori) melanocephala) melanocephala) c. c. contortrix contortrix millarius millarius prlcei) prlcei) cumanensis) cumanensis) trlgonocephatus) trlgonocephatus) c. c. conanti) conanti) c. c. ravus) ravus) contortrix) contortrix) contortrix contortrix m. m. terrificus) terrificus) plattrhlnos) plattrhlnos) guttata) guttata) callginis) callginis) p, p, bilineatus) bilineatus) laticinctus) laticinctus) Obsoleta Obsoleta contortrix contortrix m.oaxacus) m.oaxacus) piscivorus) piscivorus) millarlus) millarlus) rhinoceros) rhinoceros) lindheimeri) lindheimeri) phaeogaster) phaeogaster) cowlesi) cowlesi) barbouri) barbouri) mokasen) mokasen) pictigaster) pictigaster) Rossalleni) Rossalleni) 1 1 (4 (4 Total Total 10 10 12 12 2 2 6 6 2 2 2 2 2 2 4 4 2 2 2 2 2 2 2 2 1 1 2 2 2 2 2 2 5 5 6 6 l l 2 2 4 4 1 1 5 5 l l 2 2 1 1 2 2 1 1 1 1 1 1 1 1 1 1 3 3 1 1 3 3 1 1 1 1 1 1 3 3 1 1 1 1 1 1 ] ] 1 1 1 1 1 1 1 1 t t t t Eastems) Eastems) 11998 11998 lfon lfon ~997 ~997 lion lion ~998 ~998 ~000 ~000 bOtO bOtO ~997 ~997 ~997 ~997 !2010 !2010 !2014 !2014 11o11 11o11 ,-000 ,-000 i1oto i1oto lfot4 lfot4 ,-010 ,-010 ~>ooo ~>ooo 2.011 2.011 ~>ooo ~>ooo ~>on ~>on 1995 1995 2000 2000 2013 2013 014 014 014 014 014 014 010 010 000 000 011 011 013 013 013 013 014 014 999 999 999 999 000 000 992 992 991 991 997 997 997 997 010 010 014 014 000 000 998 998 991 991 012 012 000 000 014 014 000 000 000 000 010 010 Eastern Indigo (Drymarchon corais) 3 2012 Eastern Klnasnake (Lampropeltis getula) 5 ~990 Black Ratsnake (Elaphe obsoleta obsoleta) 5 ~970 Albino Checkered Garter Snake (Thamnophls mardanus} t ~010 Blackneck Garter Snake (Thamnophis cyrtopsis ocellatus) 1 ~014 California Red·Sided Garter Snake (Thamnophis sirtalis infemalis) 1 2010 Gopher Snake (Pituophis melanoleucus) 1 rzooo Mexican Pine Snake (Pitouphls Deppi Deppi) 2 2010 Moonshine Ratsnakes (Senticolis triaspis) 1 ~012 Albino Diamondback Watersnake (Nerodia rhomblfer) 1 12014 Mandarin Ratsnakes (Etaphe mandarina) 2 ~000 Chinese King Ratsnake {Eiaphe carinata carinata} 1 ~13 Colombian RedtailBoa Constrictor (Boa c. constrictor) 8 ~997 Black·headed Pythons {Aspidites melanocephalus) 4 12010 Woma Python (Aspldites ramsayi} 2 ~014 2 paid for & wailingto Anthill Python (Pygmy Python} (Antares;a perthensls) , ~ve} Albino Reticulated Python (Python reticulatus) ~000 Hogs Island Boa (Boa constrictor imperator) 1 ~997 Elm!rald Tree Boa (Corallus caninus) 1 ~014 Brazilian Rainbow Boa (Epicrates cenchria cenchria) 1 ~997 Honduran Milksnake (lampropeltis triangulum hondurensis) 3 2000 b. During the past five years, how many (by species, by year) successful births/hatches of each requested species or similar species have occurred at your facility? How many survived beyond 30 days? The following species were hatched since 1.1.20 I0. Most specimens are young adults or yet unpaired, hence the lack of reproduction. That should change in the coming year. Lizards #Births Banded Gila Monsters (Heloderma suspectum dnctum) 17 Snakes Western Diamondback Rattlesnake {Crotalus atrox) 12 Mojave Rattlesnake (Crotalus scutulatus) 6 Scaleless Western Diamonback Rattlesnake (Crotalus atrox) 6 Northern Copperhead (Agklstrodon contortrix mokasen) 16 Eyelash Viper (Bothriechis schlegetli} 6 c. How many mortalities of requested species or similar species, have occurred at your facility during the past five years? What were the causes? What measures have you taken to prevent future mortalities? Act Act NA. NA. The The question. question. species species 11. 11. clearly clearly conducted conducted Part Part All All license license 10. 10. enclosed enclosed for for following following this this Photographs Photographs from from both both Provide Provide d. d. A A CBW CBW facility facility regulations regulations building building 2: 2: teaches teaches Kidd Kidd The The from from Resources Resources from from We We the the exceptionally exceptionally working working Given Given detailed detailed A A Tiger Tiger Mexican Mexican Great Great Northern Northern or or depicting depicting covered covered Applications Applications zoo zoo brief brief that that have have clements, clements, a registrants registrants questions questions -- registration registration ~ ~ the the has has at at Rattlesnake Rattlesnake Basin Basin is is a a and and the the of of classes classes itself itself show show Lancehead Lancehead moved moved the the Copperhead Copperhead copy copy resume resume state state only only always always description, description, with with the the Commission Commission Rattlesnake Rattlesnake large large of of private private under under facility facility your your is is applicant's applicant's the the the the ofNC ofNC reptiles. reptiles. ofyour ofyour and and low low Walter Walter College College on on or or in in new, new, (Crotalus (Crotalus from from to to size size are are been been Rattlesnake Rattlesnake for for cage cage U.S. U.S. you you your your existing existing the the maintaining maintaining reptiles reptiles (Agkistrodon (Agkistrodon breeders, breeders, and and Renew Renew photographs photographs over over (Crotalus (Crotalus since since required required all all of of large large being being Snakes Snakes registration. registration. Kidd, Kidd, interested interested may may including including license license work work Department Department a a tlsris) tlsris) with with our our annual annual course course senior senior credit credit extensive extensive the the to to and and • (Crotalus (Crotalus CBW CBW facilities facilities "under "under collection, collection, have. have. graduated graduated o. o. and and while while a a th contortrix contortrix previous previous or or BS BS concolOI') concolOI') to to will will ~ ~ f to to animal animal report, report, of of . . ~ in in are are The The size, size, or or submit submit registrations registrations registration, registration, the the in in each each still still polystlctus) polystlctus) construction" construction" reptiles reptiles collection collection be be If If of of detailed detailed where where widely widely Business Business high high applicant applicant mokasen) mokasen) open open you you construction construction level level from from Agriculture Agriculture under under year, year, care care please please species species an an level level have have and and the the available available to to of of high high staff staff annual annual construction construction diagrams diagrams as as are are Management Management the the note note mortality mortality if if also also has has wildlife wildlife that that of of requested. requested. well well already already to to any, any, enclosed. enclosed. school school or or public public husbandry husbandry finished. finished. passed passed tation tation that that sheriff sheriff (9 (9 materials, materials, are are report report personnel personnel as as from from #Deaths #Deaths under under CFR CFR (no (no will will a a 5 5 in in over over shortly. shortly. in in responded responded 1 1 I I I I I I current current years years to to in commercial commercial the the department. department. your your The The on on blueprints, blueprints, ~ ~ 2) 2) be be show show the the present present a a NC NC activities activities and/or and/or and and 5-year 5-year maintained. maintained. that that cages cages old old answer answer Animal Animal He He Some Some inventory inventory the the Wildlife Wildlife Mr. Mr. protection protection or or to to then then will will at at reviewer reviewer period period are are any any suppliers. suppliers. the the Kidd Kidd less: less: this this pictures pictures please) please) . . s s be be to to graduated graduated Welfare Welfare standard standard license license Mr. Mr. State State the the facility. facility. of of is is that that all all are are 12. Have there been any changes to your operation such as reconstruction or new construction, new facilities, or other physical changes? If yes, please describe them. No, there have been no additions to our collection. 13. Have there been any changes to senior staff or personnel changes that would affect bow your operation handles the species included in the registration? If yes, please describe these changes. NA. See 9d above. 14. Have there been any changes to your inventory that has not been reflected in your annual reports or the current inventory list provided to the Service? If yes, please describe these changes. NA. Please refer to inventory in 9 a above. 15. Is there any additional information that you believe the Service should be aware of in regards to your operation, facilities, inventory, or business model? No. Part 3: All Applicants Should Complete 16. The Division of Management Authority annually distributes a list of Captive Bred Wildlife (CBW) Registration permittees to all CBW registration holders. The list, also available to the public, facilitates the exchange of parental stock among registered breeders; and includes permittees that operate as individuals, as well as those that arc business entities. For businesses and other organizations holding CBW registrations, including sole proprietorships, the list includes name, permit number, address, and species held by each permittee. However, the records for individuals holding CBW registrations are contained in a Privacy Act (5 U.S.C. 552a) system of records. Therefore, only the name, species, permit number, and state of residence will automatically be included on the list. The complete address will be included only upon authorization from the individual permittees. If you are not a business or organizational entity, and are applying for the CBW registration as an individual, please provide one of the following statements: Not applicable. 17. Address where you wish permit mailed (if different than page 1). Pennit should be mailed to the applicant. 18. If you wish the permit to be delivered by means other than USPS regular mail, provide an air bill, pre-paid envelope, or billing information. If you do not have a pre-paid envelope or air bill and wish to pay for a courier service with your credit card, please check the box below. Please DO NOT include credit card number or other information; you will be contacted for this information. o If a permit is issued, please send it via a courier service to the address on page 1 or question Please send by regular mail. 19. Who should we contact if we have questions about the application? (Include name, phone number, and email). Alan Shoemaker, 20. Disqualification Factor. A conviction, or entry of a plea of guilty or nolo contendere, for a felony violation of the 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 or 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? _ Yes LNoIf you answered "Yes" provide: a) the individual's name, b) date of charge, c) charge(s), d) location of incident, e) court, and t) action taken for each violation. Alan Shoemaker From: Walter Kidd Sent Wednesday, December 17, 2014 1:09PM To: Alan Shoemaker Subject: Pies Attachments: DSC00396JPG;DSC00408JPG Alan, The cage pictures are coming..... please let me know if you need more. These dip Jays do not have glass yet, it is ordered and this is only the first floor...... I will get pictures of the second floor. But last night the camera battery died n me and the contractor is working there now. Thanks! 1 VENOMOUS REPTilES • .. Cro Van.ml Croldll Hamo Wastem l ab-Yuico Tode an• DiJmonbac- Ranlt~nak• .. Attachments: Attachments: To: To: Alan Alan the the From: From: Sent Sent Subject Subject pictures pictures Thank Thank Alan, Alan, Here Here Walter Walter whole whole Shoemaker Shoemaker is is to to You! You! building building a a come come picture picture :-) :-) is is of of 4,800 4,800 the the building building sure sure Alan Alan WalterKidd Wednesday. Pictures Pictures DSC00619JPG DSC00619JPG heat heat we we Shoemaker Shoemaker and and are are of of then then Building Building remodeling remodeling ~ we we are are adding adding for for 1 1 the the a a serpentarium.l serpentarium.l second second 8PM 8PM floor floor and and only only a a gift gift have have shop shop half half to to the the my my building, building, half. half. More More but but . .