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pdfNational Marine Fisheries Service / Northeast Regional Office
Marine Fisheries Service / Northeast Regional Office
Vessel Ownership Form
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Completion of this form is required with each application for a Northeast Federal fishing permit.
List all persons and entities who have an ownership interest in the vessel that is the subject of this
application.
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Owners or persons who have an ownership interest in a vessel are defined as and include, but are not
limited to, corporations, partnerships, LLCs, persons who are shareholders in a corporation, persons
who have formed a partnership (general or limited), and any other entities that have ownership
interest in the vessel.
Section A – Vessel applying for permit
Vessel Name:
Permit or Hull Number:
Section B ‐ All persons and entities that have an ownership interest in the vessel must be listed below. Do not
include employees of the business unless they are an owner of the vessel or company.
Mr/Mrs/Ms
First Name
Check all that apply -
Mr/Mrs/Ms
Owner
First Name
Check all that apply -
Mr/Mrs/Ms
Middle Name
Middle Name
Owner
First Name
Check all that apply -
Officer
Officer
Middle Name
Owner
Officer
Last Name
Suffix Name
Shareholder
Last Name
Suffix Name
Shareholder
Last Name
Suffix Name
Shareholder
I, the undersigned, am the owner or legally authorized agent of the owner of the vessel named in Section A above. I affirm, subject
to the penalties provided in 18 U.S.C. 1001, that all information that I have given in obtaining this permit is true and correct.
OMB# 0648‐0202 Expires 04/30/2013
Name of Applicant (print clearly)____________________________________
Signature of Applicant _________________________________________ Date_____________
Please use the back of this form to provide information on all persons with an ownership interest in the vessel.
Page 2 ‐ Section B Continued ‐ All persons and entities that have an ownership interest in the vessel must be
listed below. Do not include employees of the business unless they are an owner of the vessel or company.
Mr/Mrs/Ms
First Name
Check all that apply -
Mr/Mrs/Ms
Mr/Mrs/Ms
Owner
Owner
Officer
Middle Name
Owner
First Name
Check all that apply -
Officer
Middle Name
First Name
Check all that apply -
Officer
Middle Name
First Name
Check all that apply -
Mr/Mrs/Ms
Owner
First Name
Check all that apply -
Mr/Mrs/Ms
Middle Name
Officer
Middle Name
Owner
Officer
Last Name
Suffix Name
Shareholder
Last Name
Suffix Name
Shareholder
Last Name
Suffix Name
Shareholder
Last Name
Suffix Name
Shareholder
Last Name
Suffix Name
Shareholder
I, the undersigned, am the owner or legally authorized agent of the owner of the vessel named in Section A above. I affirm, subject
to the penalties provided in 18 U.S.C. 1001, that all information that I have given in obtaining this permit is true and correct.
OMB# 0648‐0202 Expires 04/30/2013
Name of Applicant (print clearly)____________________________________
Signature of Applicant _________________________________________ Date_____________
Please copy this form as needed to provide information on all persons with an ownership interest in the vessel
in Section A.
| File Type | application/pdf |
| File Title | NORTHEAST FEDERAL FISHERIES – INITIAL VESSEL APPLICATION INSTRUCTIONS |
| Author | Don Paskowski |
| File Modified | 2011-02-24 |
| File Created | 2011-02-24 |