Pacific HMS Vessel Permit Application

U.S. DEPARTMENT OF COMMERCE OMB#: 0648-0204 NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION APPROVAL EXPIRES: 08/31/2013 NATIONAL MARINE FISHERIES SERVICE 501 WEST OCEAN BLVD SUITE 4200 Permit Application Fee: $30 LONG BEACH, CA 90802 Pacific Highly Migratory Species Vessel Permit Application

SECTION 1 VESSEL INFORMATION (please print legibly or type)

USCG DOC. OR STATE REG. NO. VESSEL

VESSEL NAME

HULL IDENTIFICATION NUMBER

HOME PORT AND STATE

USCG DOCUMENTED HAIL PORT AND STATE

RADIO CALL SIGN

DOES THIS VESSEL HAVE AN OPERATIONAL VMS? YES NO

REGISTERED LENGTH (FT.)

REGISTERED BREADTH (FT.)

REGISTERED DEPTH (FT.)

GROSS TONS

NET TONS

HOLD CAPACITY (SHORT TONS)

HOLD CAPACITY (METRIC TONS)

HOLD CAPACITY (CUBIC METERS)

PROPULSION TYPE

REFRIGERATION TYPE

HORSEPOWER

HULL MATERIAL

YEAR BUILT

LOCATION BUILT

CREW SIZE (INCLUDING OFFICERS)

PASSENGER CAPACITY

PREVIOUS VESSEL NAMES VESSEL FLAG EFFECTIVE DATES

SECTION 2 SELECT THE TYPE OF GEAR TO BE AUTHORIZED BY THE HMS PERMIT

COMMERCIAL:

RECREATIONAL:

HARPOON

PURSE SEINE

CHARTER VESSEL

TROLL/JIG

N LONGLINE

o

DRIFT GILLNET

BAITBOAT

SECTION 3 VESSEL OWNERSHIP INFORMATION

EACH HOLDER OF THIS PERMIT (INCLUDING ALL MEMBERS OF AN ASSOCIATION OR JOINT VENTURE) IS A U.S. CITIZEN. IF THE VESSEL IS OWNED BY A TRUST, PARTNERSHIP, CORPORATION, THE PERMIT HOLDER IS AN "ELIGIBLE OWNER" AS DESCRIBED ON PAGE TWO OF THIS FORM YES NO

COMPANY NAME

DATE CORPORATION FILED

EIN/SSN

DUNNS NO.

BUSINESS ADDRESS

CITY

STATE

ZIP

BUSINESS TELEPHONE

BUSINESS FAX

BUSINESS CELL PHONE

BUSINESS E-MAIL

MANAGING OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

SECOND OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

THIRD OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

SECTION 4 SIGNATURE (All applications must be signed and dated)

I certify that the above information is complete, true, and correct to the best of my knowledge and belief.

OWNER'S SIGNATURE:

NAME: (Print legibly or type)

DATE:

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General - This information is being collected by the National Marine Fisheries Service to ensure that timely and accurate records are available concerning the fishing vessels of the U.S. that participate in Pacific Ocean fisheries for highly migratory species, consistent with the requirements of the Fishery Management Plan for U.S. West Coast Fisheries for Highly Migratory Species. The collection of information concerning U.S. fishing vessels harvesting tuna in the eastern Pacific Ocean is also necessary for the U.S. to comply with its obligations as a member of the Inter-American Tropical Tuna Commission.

This permit is required for commercial fishing vessels and recreational charter vessels that harvest any of the species that are included in the FMP. They are: Billfish/Swordfish: striped marlin (Tetrapturus audax); swordfish (Xiphias gladius). Sharks: common thresher shark (Alopias vulpinus); pelagic thresher shark (Alopias pelagicus); bigeye thresher shark (Alopias superciliosus); shortfin mako or bonito shark (Isurus oxyrinchus); blue shark (Prionace glauca). Tunas: north Pacific albacore (Thunnus alalunga); yellowfin tuna (Thunnus albacares); bigeye tuna (Thunnus obesus); skipjack tuna (Katsuwonus pelamis); northern bluefin tuna (Thunnus orientalis). Other: dorado or dolphinfish (Coryphaena hippurus)

Eligible Owner – The following vessel owners are eligible to hold a Pacific HMS Permit:

(1) An individual who is a citizen of the United States.

(2) An association, trust, joint venture, or other entity if— (A) each of its members is a citizen of the United States; and (B) it is capable of holding title to a vessel under the laws of the United States or a State.

(3) A partnership if— (A) each general partner is a citizen of the United States; and (B) the controlling interest in the partnership is owned by citizens of the United States.

(4) A corporation if— (A) it is incorporated under the laws of the United States or a State; (B) its chief executive officer, by whatever title, and the chairman of its board of directors are citizens of the United States; and (C) no more of its directors are noncitizens than a minority of the number necessary to constitute a quorum.

(5) The United States Government.

(6) The government of a State.

Instructions -

Section 1 - Enter vessel information as it appears on the Coast Guard documentation or, if the vessel is not Coast Guard documented, as it appears on the state registration certificate.

Hull Identification Number - If your vessel does not have a hull identification number leave the box blank.

Home Port - Enter the city and state where the vessel is customarily kept, not necessarily the home port listed on the certificate of documentation.

Hail Port - Enter the city and state listed on the certificate of documentation

Radio Call Sign - If your vessel has no radio, leave blank

Operational VMS - Global positioning system using satellites to track vessel movements

Hold Capacity - Cubic Meters is preferred; however, Short Tons or Metric Tons are acceptable

Provide all other information required to the best of your ability.

Section 2 - For commercial fishing vessels, mark only gears that the vessel will use to harvest highly migratory species. Indicate only whether a recreational vessel is a charter or commercial passenger fishing vessel (CPFV). It is not necessary to list any gear for recreational vessels.

Section 3 - Enter an Employer Identification Number (EIN) if you have one, and the vessel owners' Social Security Number(s). The owner's date of birth will be used as an additional identifier and to establish the two-year renewal date for the permit. Enter the month, day, and year. Contact information for all owners of the vessel is required. If there are more than three owners, use an additional sheet. It is recommended that vessel owners obtain a DUNNS Number by contacting Dunn and Bradstreet at their website: www.dnb.com.

Privacy Act Statement: Federal Regulations (at 50 CFR Part 660) 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, disclosure is mandatory in accordance with the Debt Collection Act (31 U.S.C. 7701).

Your Social Security Number (SSN) is confidential and is protected under the Privacy Act. Disclosure of your SSN is mandatory. The primary purpose for requiring the SSN and EIN is to verify the identity of individuals/entities doing business with the government as required by the Debt Collection Improvement Act of 1996 (Public Law 104-134).

Paperwork Reduction Act - Public reporting burden for this collection of information is estimated to average 40 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining data, and completing and reviewing the collection of information. Notwithstanding 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Regional Administrator, National Marine Fisheries Service, 501 West Ocean Blvd., Long Beach, CA 90802-4213.

^Permit application fee: $30.00 ^{Payable to "US Department of Commerce – NOAA}

^{"Please write your Vessel number and name in the memo section of your check.}

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