Change of vessel registration permit owner or vessel own

OMB Control No. 0648-0203
Expiration Date: 09/30/2009

Change of Vessel
Registration , Permit Owner
or Vessel Owner Application
Pacific Coast Groundfish
Limited Entry Permit

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service
NorthPacific Region , Fisheries Permits Office
7600 Sand Point Way NE, Bldg. 1
Seattle, WA 98115-0070
Phone (206) 526-4353

Fax (206) 526-4461

www.nwr.noaa.gov

INSTRUCTIONS
REMINDER: Please provide your current limited entry permit with the completed transfer request form.
SECTION A - ACTION(S) REQUESTED: Please check the box next to the action(s) requested. Fill out the sections
listed for each action. If multiple permits are being combined to either increase the size endorsement or to stack
(sablefish-endorsed only), a separate form must be completed for each permit. For actions that include a change in
vessel registered to a sablefish-endorsed permit, there are three sub-actions that can be taking place (stacking, moving,
or removing).
1.
If a sablefish-endorsed permit is being stacked, going from an “unidentified” vessel status to a named vessel,
check the first sub-box under “change in vessel registered to a permit.”
2.
If a sablefish-endorsed permit is being moved, going from one named vessel to another named vessel, check the
both sub-boxes under “change in vessel registered to a permit.”
3.
If a sablefish-endorsed permit is being removed, going from a named vessel to an “unidentified” vessel status,
check the second sub-box under “change in vessel registered to a permit.”
SECTION B - CURRENT PERMIT OWNER: List permit number, vessel name currently registered to the permit, and
vessel registration number. List each permit owner(s) name as given on the current permit. Enter Tax Identification
number (TIN) and/or date of birth (DOB) of the current permit owner(s). This section must be signed by an authorized
individual for business entities or all permit owner(s) required to sign for NMFS to implement the designated actions (See
NOTE 1 below). A signed and dated corporate resolution is required from business entities authorizing an individual to
sign the form on behalf of the corporation/partnership. The current permit owner(s) or authorized permit owner(s) must
sign and date the application in the presence of a notary to certify that the individual(s) signing the form have satisfactorily
identified themselves. The notary must sign and date the certification statement, and affix their notary stamp or seal. By
signing and dating the application, the applicant certifies that all information set forth in the application is true, correct, and
complete to the best of the applicant’s knowledge and belief. For sablefish endorsed permits, if the permit owner is a
business entity, an ownership interest form must be submitted.
If the space provided in this section is not adequate to list all owners required to sign the form, attach a separate sheet
with the heading: “Section B - Current Permit Owner - Attachment.” Please provide permit owner names, SSN/TIN,
signatures, date of signature, and notarize the separate sheet. Note the Privacy Act Statement at the end of the
application.
SECTION C - CHANGE OF VESSEL REGISTERED TO PERMIT: If you are changing the vessel registered to the
permit, please indicate the name and registration number of the current vessel listed on the permit on the left side of
Section C and list the name and registration number of the new vessel on the right side of Section C. List the length
overall of both the current and new vessels. If the permit will not be registered to a vessel, indicate “unidentified” for the
new vessel name. A recent marine survey (conducted in last 3 years) must be provided for a vessel not currently
registered to a limited entry permit to verify its length overall.
SECTION D - NEW PERMIT OWNER: List each new permit owner’s name(s), a business address and phone number.
Enter the Tax Identification number (TIN) (if business entity) date of birth (for an individual) for the new permit owner. If
the space provided in this section is not adequate to list all owners, attach a separate sheet with the heading: “Section D New Permit Owner - Attachment.” Please provide permit owner names and TIN or date of birth. The new permit owner is
requested (optional) to provide the permit sale price. Note the Privacy Act Statement at the end of the application.

PACIFIC COAST CHANGE OF VESSEL REGISTRATION OR PERMIT OWNER/VESSEL OWNER APPLICATION - PAGE 1OF 5

OMB Control No. 0648-0203
Expiration Date: 09/30/2009

SECTION E - VESSEL OWNER: Please provide the name of the owner(s) of the vessel to be registered to the permit as
given on the U.S. Coast Guard Certificate of Documentation or state vessel registration document. Please provide the
individual(s) or business name, business address and phone number. If the vessel owner is different from the listed
permit owner, enter the Tax Identification number (TIN) and/or date of birth (DOB). If the space provided in this section is
not adequate to list all holders, attach a separate sheet with the heading: “Section E - Permit Holder - Attachment.”
Please provide vessel owner names and the TIN (if business entity) or date of birth (DOB) for individuals. The new permit
holder is requested (optional) to provide the permit lease price and period of the lease. For sablefish endorsed permits,
if the vessel owner is a business entity, an ownership interest form must be submitted.
SECTION F - SABLEFISH-ENDORSED PERMIT TRANSFER: Fill out this section if you are requesting a transfer of a
sablefish-endorsed permit at any time during the primary sablefish season. This section requires the transferor to certify
the cumulative amount of sablefish landings for the current primary sablefish season on the permit at the time of transfer
and requires the transferee to acknowledge the amount of sablefish the cumulative amount of sablefish landings on the
permit to date. In the case of an enforcement investigation on a sablefish-endorsed permit, the transferor may be held
liable for certifying false landings during a mid-season transfer of a permit.
Eligibility to own or hold a Pacific Coast Groundfish Limited Entry Permit: Please note that a Pacific Coast Groundfish
Limited Entry Permit owned or registered to a person eligible to own a U.S. documented vessel.
NOTE 1: Persons who sign on behalf of an entity or another party, need to submit evidence of authority to sign such as:
notarized power of attorney, corporate resolutions, certified court documents relative to divorce decrees and judgments or
appointments as executor, etc. If the permit is owned by co-owners, both owners must sign.
NOTE 2: Persons eligible to own a documented vessel are:
$
$
$
$
$
$

an individual who is a citizen of the United States
an association, trust, joint venture or other entity a) all of whose members are citizens of the United States; and
b) that is capable of holding title to a vessel under the laws of the United States or of a State
a partnership whose general partners are citizens of the United States
a corporation established under the laws of the United States or of a State, whose president or other chief
executive officer and chairman of the board of directors are citizens of the United States and no more of
its directors are non-citizens than a minority of the number necessary to constitute a quorum;
the United States Government;
the government of a State.

Please mail this application with your current limited entry permit and other required supporting documentation to the
address listed at the top of the instructions page.

PACIFIC COAST CHANGE OF VESSEL REGISTRATION OR PERMIT OWNER/VESSEL OWNER APPLICATION - PAGE 2 OF 5

OMB Control No. 0648-0203
Expiration Date: 09/30/2009

Change of Vessel
Registration Permit Owner
or Vessel Owner Application

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service
Northwest Region , Fisheries Permits Office
7600 Sand Point Way NE, Bldg. 1
Seattle, WA 98115-0070

Pacific Coast Groundfish
Limited Entry Permit

Phone (206) 526-4353

Fax (206) 526-4461

www.nwr.noaa.gov

“ Change in vessel registered to permit (Fill out Sections B, C & F)
“ Is this a request to stack a sablefish-endorsed permit?
“ Is this a request to remove a sablefish-endorsed permit from
an existing stack arrangement?

“ Change in permit owner (Fill out Sections B, D & F)
“ Change in vessel owner (Fill out Sections B, E & F)
SECTION B - CURRENT PERMIT OWNER
Vessel Name

Permit Number

USCG Doc or State Registration Number

GF
Current Permit Owner Name(s) (Last, First, Middle Name or Business Name)
Business Name

Last

Business Mailing Address

First

Tax Identification Number (TIN)
corporate or business entity)

Middle Name

“ Is this a change of address?

(For each

Date of Birth (For each individual)

Business Phone

(

)

Street or PO Box
Business Fax (optional)

(
City

State

Zip Code

)

Business Email (optional)

The remainder of Section B must be completed by a notary to certify that
the individual(s) signing this form have satisfactorily identified themselves.
Under penalties of perjury, I hereby declare that I, the undersigned, completed this application, and the information contained herein is true, correct,
and complete to the best of my knowledge and belief.
Signature of Applicant or Authorized Representative (See Note 1)

Date

Printed Name of Applicant or Authorized Representative (NOTE: If form completed by a representative, attach authorization.)

Notary Public Signature

Date Commission Expires

“

ATTEST

Affix Notary Stamp or Seal Here

OMB Control No. 0648-0203
Expiration Date: 09/30/2009

SECTION C - CHANGE OF VESSEL REGISTERED TO PERMIT
CURRENT Vessel Name

NEW Vessel Name

USCG Doc or State Registration Number

USCG Doc or State Registration Number

Length Overall

feet

Length Overall

feet

For the new vessel, submit a copy of the US Coast Guard “Certificate of Documentation” (CG-1270) or the registration certificate issued by a state.
Also submit a marine survey documenting vessel length overall (LOA). The survey must be conducted by a certified marine surveyor according to the
USCG method for determining LOA. NOTE: In order to register a permit for use with a given vessel, the vessel owner must be listed as either the
permit owner or holder.

SECTION D - NEW PERMIT OWNER
New Permit Owner Name(s) (Last, First, Middle Name or Business Name)
Business Name

Last

First

Tax Identification Number (TIN)
corporation or business entity)

Middle Name

“ Is this a change of address?

Business Mailing Address

Date of Birth

(For each

(For each individual)

Business Phone

(

)

Street or PO Box
Business Fax (optional)

(
City

State

Zip Code

Business Email (optional)

Are you a person eligible to own a documented vessel under the terms of 46 USC 12102 (a)? (See Note 2)

Permit sale price (optional)

)

“ yes “ no

$_____________________ (U.S. dollars)

(As

SECTION E - VESSEL OWNER
given on USCG Form 1270 or State Motorboat License)

Permit Holder/Vessel Owner Name(s) (Last, First, Middle Name or Business Name)
Business Name

Last

First

Business Mailing Address

TIN (If multiple owners, attach a list of their
names and TIN)

Middle Name

“ Is this a change of address?

DOB (If multiple owners, attach a list of their
names and DOB)

Business Phone

(

)

Street or PO Box
Business Fax (optional)

(
City

State

Zip Code

Business Email (optional)

Are you a person eligible to own a documented vessel under the terms of 46 USC 12102 (a)? (See Note 2)

Permit lease price (optional)

$_____________________ (U.S. dollars)

)

“ yes “ no

Period of lease (optional) __________________

PACIFIC COAST CHANGE OF VESSEL REGISTRATION OR PERMIT OWNER/VESSEL OWNER APPLICATION- PAGE 4

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OMB Control No. 0648-0203
Expiration Date: 09/30/2009

SECTION F - SABLEFISH-ENDORSED PERMIT TRANSFER
Fill out this section if you are transferring a sablefish-endorsed permit.
Is the permit transfer occurring during the primary sablefish season (usually April-October)?

“ YES

If yes, please provide the cumulative sablefish in pounds (round weight) that has been landed to date against the permit’s tier amount
__________________ pounds

“ NO

If no, no further information is required in this section.

Current Permit Owner (Transferor): I certify that the cumulative amount of landed sablefish given above has been credited against the permit listed
on this form and is accurate as of the date of my signature below. Further, I certify that the cumulative amount of landed sablefish for this permit
(given above) occurred during the current primary sablefish season and has been reported on fish landing tickets.
Printed Name of Current Permit Owner

Signature of Current Permit Owner

Date

New Permit Owner or Owner of Vessel Registered to the Permit (Transferee): I acknowledge that the cumulative amount of landed sablefish
given above has been credited against the permit listed on this form and reflects cumulative landings during the current primary sablefish season.
Further, I acknowledge that the difference between the total tier poundage available on this permit minus the amount given above is the amount of
sablefish remaining to be harvested during the current primary sablefish season.
Printed Name of New Permit Owner or Vessel Owner

Signature of New Permit Owner or Vessel Owner

Date

WARNING STATEMENT: A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under 15 CFR 904, a civil penalty
of up to $100,000 under 16 USC 1858, and as a federal crime under 18 USC 1001.
PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 0.5 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 NOAA/National Marine Fisheries
Service, Northwest Region, Attn: Assistant Regional Administrator, Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115.
PRIVACY ACT STATEMENT: Your date of birth and TIN are confidential and protected under the Privacy Act. Provision of your date of birth and TIN is mandatory as
part of this collection. The primary purpose for requiring the date of birth is to verify the identity of individuals/entities doing business with the government to provide a
unique identification for assistance to comply with the Debt Collection Improvement Act of 1996 (Public Law 104-134) and for enforcement activities.
The information collected is part of a Privacy Act System of Records, COMMERCE/NOAA #19, Permits and Registrations for United States Federally Regulated
Fisheries. A notice was published in the Federal Register on April 17, 2008 (73 FR 20914) and became effective on June 11, 2008 (73 FR 33065).

ADDITIONAL INFORMATION: Before completing this form, please note the following: 1) This information is collected to manage and conserve the Pacific Coast
Groundfish fishery and more specifically, to maintain accurate and current records on all permit owners, permit holders and vessels registered to participate in the
Pacific Coast Groundfish Limited Entry Program. This information will be used to formally document a request from the permit owner to make a change to a permit and
allow the Agency to review and verify that such a request is in compliance with existing regulations, to monitor and analyze changes in participation in Pacific Groundfish
fishery, accurately record changes to the listed permit owner, permit holder or vessel registered to the permit, and maintain accurate and current address and contact
information of permit owners and holders to allow the Agency to notify them of changes in the fishery regulations. 2) This collection of information is mandatory and a
change in registration of limited entry permits is required at 50 CFR Section 660.335 (b-i). 3) Responses to this information request are confidential under Section 402(b)
of the Magnuson-Stevens Act (16 U.S.C. 1801, et. seq.). It is also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect
confidentiality of fishery statistics. These procedures have been implemented under the NMFS Operations Manual entitled, “Data Security Handbook of the Northwest
and Alaska Region, National Marine Fisheries Service”. Not withstanding any other provision of the 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.

PACIFIC COAST CHANGE OF VESSEL REGISTRATION OR PERMIT OWNER/VESSEL OWNER APPLICATION- PAGE 5

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