Price $1.00 Please complete this application form and submit per the instructions at dmr.ms.govEnsure that all information is accurate and complete. 1. Application FeeA non-refundable application fee of $50 must be paid at the time of submission. If you were provided a coupon code because you submitted an application last year, enter the code on the payment page to waive the $50 fee. 2. Applicant Information Name Address Street address Street address line 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)CaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMicronesiaMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code Email Phone Number 3. Are you a resident of the State of Mississippi? Yes No Not Applicable MS Drivers License Number 4. Are you organized under the state laws and registered with the Secretary of State's Office? Yes No Not Applicable Name as Registered with Secretary of State's office Is your company owned by a Mississippi resident? Yes No Experience in Reef Development 5. Has the applicant previously held a valid Private Oyster Lease in Mississippi or any other state? If so, please indicate the length of time the private lease has been held? 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years Upload the supporting documentation items: On-Bottom Lease Agreement for any state Add a new file Unlimited number of files can be uploaded to this field.50 MB limit.Allowed types: jpeg jpg png pdf. 6. How many years of relevant experience does the applicant have related to cultch planting and reef development? 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years Upload the supporting documentation items: State Contracts, Receipts, Permits, Relevant experience Add a new file Unlimited number of files can be uploaded to this field.50 MB limit.Allowed types: jpeg jpg png pdf. Experience in Oyster Cultivation & Harvesting 7. How many years experience do you have harvesting oysters? 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years Upload the supporting documentation items: Trip tickets with associated Harvest Licenses Add a new file Unlimited number of files can be uploaded to this field.50 MB limit.Allowed types: jpeg jpg png pdf. 8. Over the past ten years, how many cubic yards have you planted for a lease/contract? 1-2,500 2,501-5000 5,001-7,500 7,501-10,000 10,001-12,500 12,501-15,000 15,001-17,500 17,501-20,000 20,001-22,500 22,501-25,000 25,001-27,500 27,501-30,000 30,001-32,500 32,501-35,000 35,001-37,500 37,501-40,000 40,001-42,500 42,501-45,000 45,001-47,500 47,501-50,000 Upload the supporting documentation items: Material purchase receipts, Barge receipts Add a new file Unlimited number of files can be uploaded to this field.50 MB limit.Allowed types: jpeg jpg png pdf. 9. What is the total length of time that the applicant has been registered on the US FDA ICSSL for Mississippi? Not Certified 1 Year or Less 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years Certificate Number Lease Acreage 10. In which Zone is the application lease area located? Zone 1 Zone 2 Zone 3 Zone 4 Zone 5 Zone 6 Zone 7 Zone 8 Zone 9 11. Acreage for THIS application 12. The MDMR will review and calculate the amount of acreage to be leased by considering both the proposed acreage per zone and the total proposed acreage from all applications, including any currently leased acreage.Scoring Rubric: Total Acreage of lease applications and current leases (in MS) divided by 10 Points in 125 acre increments 13. List the proposed coordinates of the water bottoms being requested. Lease Latitudes/Longitudes must be in decimal degrees. To identify the coordinates, Click here to access the MDMR Oyster Lease Application Map Table Caption This brief caption will be associated with the table and will help screen reader better describe the content within. Weight -9-8-7-6-5-4-3-2-10123456789 Coordinates Latitude Longitude Weight -9-8-7-6-5-4-3-2-10123456789 1 Weight -9-8-7-6-5-4-3-2-10123456789 2 Weight -9-8-7-6-5-4-3-2-10123456789 3 Weight -9-8-7-6-5-4-3-2-10123456789 4 Weight -9-8-7-6-5-4-3-2-10123456789 5 Weight -9-8-7-6-5-4-3-2-10123456789 6 Weight -9-8-7-6-5-4-3-2-10123456789 7 Weight -9-8-7-6-5-4-3-2-10123456789 8 Financial StabilityAs part of the overall application process, you will be required to upload proof of financial stability into a separate secure portal.After submitting this application, you will receive an email with instructions on how and where to upload the required financial documentation.Failure to provide this additional information within the allotted time period will result in your application being rejected.The Financial Stability portion of the application is worth a maximum of 20 points. By checking this, I agree to all the mentioned above I understand prior to signing the lease agreement, it is my responsibility to read and comply with all terms and conditions of the lease agreement.I certify that I am a resident of the State of Mississippi, or if a firm or corporation, such firm or corporation shall be organized under the laws of the State of Mississippi.I understand that I will be responsible to install and maintain lease markers. All leases shall be marked by appropriate poles, stakes or buoys of such material as will not injure watercraft, at the expense of the leaseholder.An application fee of $50.00 is required to be submitted with the lease application. By checking this, I agree to all the mentioned above Name Phone Number Signature Box Clear I hereby declare that the information provided in this application is true and accurate to the best of my knowledge. I understand that any false statements or misrepresentations may result in the rejection of my application.By submitting, I certify that I have read and understand all regulations of Title 22 – Mississippi Department of Marine Resources Part 1 Rules and Regulations for Molluscan Shellfish Related Activities and agree to abide by the terms as stated.
