Identification of Ownership Interest

Revised: 06/23/2005

OMB No. 0648-0272; Expires 04/30/2008

QUOTA SHARE HOLDER:
IDENTIFICATION OF
OWNERSHIP INTEREST

U.S. Dept. of Commerce/NOAA
National Marine Fisheries Service
Restricted Access Management
P.O. Box 21668
Juneau, AK 99802-1668
(800) 304-4846 toll free / 586-7202 in Juneau (907) 586-7354 fax

Quota Share Holder:

BLOCK A - IDENTIFICATION OF QUOTA SHARE HOLDER

1. Is this business a publicly held corporation?

[ ] Yes [ ] No

2. a. Is this a corporation or partnership?
b. If yes, is this entity still active?

[ ] Yes [ ] No
[ ] Yes [ ] No

3. Is this an estate that has been probated?
[ ] Yes [ ] No
If yes, on what date was probate finalized: __________________
BLOCK B - IDENTIFICATION OF SHAREHOLDERS, PARTNERS, JOINT VENTURERS, SUCCESSOR-IN-INTERESTS
NOTE: IF OWNERSHIP CONSISTS OF SEPARATE/ADDITIONAL CORPORATIONS OR PARTNERSHIPS THE INDIVIDUAL OWNERS OF THOSE ENTITIES AND THE PERCENTAGE OF
INTEREST THOSE INDIVIDUALS HOLD IN THEIR RESPECTIVECORPORATIONS OR PARTNERSHIPS MUST ALSO BE LISTED.

1. NAME (Print or Type)

2. IFQ ID or Tax ID or SSN (optional )

3. Percent (%) of
Interest Held

TOTAL OWNERSHIP:

100 %

4. Do these ownership percentages represent the addition of any new owners since Quota Share was
initially issued? Yes [ ] No [ ]
BLOCK C - CERTIFICATION
Under penalty of perjury, I declare that I have examined this form, and to the best of my knowledge and belief, the
information I have presented here is true, correct and complete.
1. Signature

2. Date

3. Printed Name

4. Title

5. Signature of Notary Public

6. Affix Notary Stamp or Seal Below

7. Commission Expires

Rev. 06/23/2005

OMB No. 0648-0272; Expires 04/30/2008

INSTRUCTIONS

Quota Share Holder: Identification of Ownership Interest

This form must be submitted by corporations, partnerships, and other non-individual entities who hold Quota Share (QS) under the
Pacific halibut and sablefish Individual Fishing Quota (IFQ) program (50 CFR Part 679). Please type, or print legibly in ink; you
may photocopy and attach additional sheets as necessary. Please sign in ink, have your signature notarized, retain a copy for your
records, and mail the completed form to: NMFS Alaska Region, Restricted Access Management (RAM), P.O. Box 21668,
Juneau, AK 99802-1668. For information, contact RAM at 800-304-4846 or 907-586-7202.
GENERAL INFORMATION
The information requested herein is needed by RAM to determine compliance with two IFQ program requirements, including:
1) Limitations On Use of QS and IFQ. This information is needed to determine if persons who hold QS have exceeded
their allowable use limits under the “individually and collectively” language set out in the IFQ regulations at 50 CFR
679.42(e) and (f); and,
2) Changes in corporations or partnerships. This information is also needed to determine if a Corporation or Partnership
has changed. Under Sec. 679.42(j)(1) - (4), upon a “change” (i.e., the addition of a new member) to a corporation or
partnership that holds catcher vessel QS, the entity may no longer hire a master to fish the IFQ resulting from the QS it holds;
further, such an entity must notify NMFS of the change within 15 days of its effective date and must then transfer its QS to a
qualified individual.
SPECIFIC INSTRUCTIONS
BLOCK A - IDENTIFICATION OF QUOTA SHARE HOLDER
1.

Indicate if the Quota Share holder is a publicly held corporation. If yes, sign the certification in Block C and return the form
to RAM.

2.

(a)
(b)

Indicate if this is a corporation or partnership.
Indicate if the entity is still active. If yes, go to Block “B”. If no, sign the certification in Block C and return the form to
RAM.

3.

If the non-individual Quota Share holder is an estate and all estate matters with regard to the disposition of the assets ,
including Quota Share have been finalized you must answer “YES”. Please provide the date the estate was settled.

BLOCK B - IDENTIFICATION OF MEMBERS
1.

List the names of members. If a member is itself a corporation, partnership, or other such entity, you must also list the
owners of that member at this time.

2.

Enter the Social Security number (SSN), IFQ Identification number, or Tax Identification number of each member.
Privacy Act Statement: Federal regulations (at 50 CFR Part 679) authorize collection of this information. This
information is used to verify the identity of the applicant(s) and to accurately retrieve confidential records related to
federal commercial fishery permits. Where the requested information is a Social Security Number (SSN), disclosure is
voluntary; in the event it is not provided, NMFS will assign a unique code that will identify the records.

3.

4.

Enter the percentage of ownership interest that each constituent member holds; for example, if there are three equal
owners, enter "33-1/3" for each. The total interest of all members should equal 100 percent.
If any of the owners listed have been added since Quota Shares was issued you must answer “yes”

BLOCK C - CERTIFICATION
1-3. Sign and date the application in the presence of Notary Public, and print your name.
4.

Authorized representatives must submit proof of authorization from QS owner and state title.

5-7. To be completed by a Notary Public, not the person submitting this application.

PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average [0.2 hours] per response, including
the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing the burden, to Assistant Regional
Administrator, Sustainable Fisheries Division, NOAA National Marine Fisheries Service, P.O. Box 21668, Juneau,
AK 99802.
ADDITIONAL INFORMATION
Before completing this form please note the following: 1) Not withstanding any other provision of law, no person is
required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of
information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays
a currently valid OMB Control Number; 2) This information is mandatory and is required to manage commercial
fishing efforts under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801,
et seq.); 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act (16 U.S.C.
1801, et seq.). They are also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect
confidentiality of fishery statistics.”