Change of vessel registration permit owner or vessel own

OMB Control No. 0648-0203; Expiration Date:06/30/2013

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

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
Phone (206) 526-4353

Fax (206) 526-4461

www.nwr.noaa.gov

INSTRUCTIONS
SECTION A - ACTION(S) REQUESTED: Please check the box next to the action(s) requested. Fill out the sections
listed for each action. For actions that include a change in vessel registered to a sablefish-endorsed permit, there are
three sub-actions that may take 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: Please provide the 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 and the Tax
Identification Number (TIN) for a business entity and/or date of birth (DOB) for an individual who is the current permit
owner. Either current permit owner(s) or an authorized representative of the permit owner must sign and date the form
(See Note Below). A notary must sign and date the certification section, and affix their notary stamp or seal. By signing
and dating the application, the applicant certifies that they are authorized to sign this form and that all information set forth
in the application is true, correct, and complete to the best of the applicant’s knowledge and belief.
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, signatures, date
of signature, and notarize the separate sheet.
SECTION C - CHANGE OF VESSEL REGISTERED TO PERMIT: If you are changing the vessel registered to the
permit, please print the current vessel name/number registered to the permit and new vessel name and registration
number to be registered to the permit. The “new” vessel name/registration will appear on the reissued permit. 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. If NMFS does not have a recent marine survey for the vessel on file, the permit or vessel owner
must provide recent marine survey (conducted in last 3 years) with the length overall measurement to process the
request. If you are requesting the registration of a new vessel to the permit, please fill out Section E.
SECTION D - NEW PERMIT OWNER: Please provide each new permit owner’s name(s), a business address and
phone number. Enter the Tax Identification Number (TIN) (if business entity) or date of birth (for an individual) for each
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 check the appropriate box to indicate if the new
permit owner is eligible to own a U.S. documented vessel (See Note below).
SECTION E - VESSEL OWNER: If registering a new vessel to the permit or if the vessel owner has changed, please
provide the name of all owner(s) of the vessel as given on either the U.S. Coast Guard Certificate of Documentation
(USCG 1270) or state vessel registration document, a business address and phone number. Please provide for each
business entity the Tax Identification Number (TIN) and for each individual their 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
– Vessel Owner - Attachment.” Please provide vessel owner names and the TIN (if business entity) or date of birth (DOB)
for individuals. For sablefish endorsed permits, if the vessel owner is a business entity, an ownership interest
form must be submitted.

SECTION F - SABLEFISH-ENDORSED PERMIT: If you are requesting a change in permit owner, vessel registration
and/or vessel owner of a sablefish-endorsed permit at any time during the primary sablefish season (April 1 – October
31), you must complete this section.
This section requires the transferor to give the cumulative amount of sablefish landings against the tier allocation for the
current primary sablefish season at the time of transfer and to certify this landing amount by signing and dating this
section. Similarly, the transferee (new permit owner or vessel owner) must acknowledge the cumulative amount of
sablefish landings given in this section by signing and dating this section.
SUPPLEMENTAL DOCUMENTATION:
Please submit your current limited entry permit with the completed transfer request form.
If registering a new vessel to the permit provide the following: 1) If not already on file with NMFS, a marine survey
completed in the last 3 years with a length overall measurement for the vessel; and 2) a copy of USCG vessel
documentation or state vessel registration document.
Sablefish Endorsed Permits: If changing permit ownership or vessel registration or ownership on a sablefish
endorsed permit and a business entity will be the permit owner or vessel owner on the reissued permit, please
provide a sablefish ownership interest form for each business entity,
NMFS may require other documents necessary to determine if such request should be approved. Among the documents
NMFS may require include (but not limited to): notarized power of attorney, corporate resolution, certified court
documents relative to divorce decrees and judgments or appointments as executor, death and marriage certificates, etc.

Permit Owner Note: If there are multiple permit owners, and the owners names are joined by the word “and” all
owners must sign and date the form. If there permit owner names are joined by the word “or” any one owner can
authorize the request on behalf of all owners.
Eligibility to own or hold a Pacific Coast Groundfish Limited Entry Permit: Please note that a Pacific Coast
Groundfish Limited Entry Permit must be owned or registered by a person eligible to own a U.S. documented vessel.
Persons eligible to own a documented vessel include:


an individual who is a citizen of the United States



an association, trust, joint venture or other entity a) Where all members are citizens of the United States; and
b) 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;

OMB Control No. 0648-0203; Expiration Date:

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

SECTION A – ACTION(S) REQUESTED

 Change in vessel registered to permit (Fill out Sections B, C, E & 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
 Change in vessel owner

(Fill out Sections B, D & F)
(Fill out Sections B, E & F)

SECTION B - CURRENT PERMIT OWNER
Permit Number

USCG Doc or State Registration Number

Vessel Name

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

Last

Business Mailing Address

First

Tax Identification Number (TIN) (business
entity)

Middle Name

 Is this a change of address?

Date of Birth (DOB) (individual)

Business Phone

(

)

Street or PO Box
Business Fax (optional)

(
City

State

Zip Code

)

Business Email (optional)

Permit Owner Certification and Notary
(Please note that a notary must sign, date and stamp this Section).
Under penalties of perjury, I hereby declare that I, the undersigned, am authorized to complete and certify this application on behalf of the permit
owner(s), and the information contained herein is true, correct, and complete to the best of my knowledge and belief.
Date

Signature of Applicant or Authorized Representative

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

Notary Public Signature



ATTEST

Date Commission Expires

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Affix Notary Stamp or Seal Here

OMB Control No. 0648-0203; Expiration Date:

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

NEW Vessel:

USCG or State Vessel Registration No.:

USCG or State Vessel Registration No.:

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 state vessel registration certificate. Also
submit a marine survey documenting vessel length overall (LOA).

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

First

Last

Business Mailing Address

Tax Identification Number (TIN) (business
entity)

Middle Name

 Is this a change of address?

Date of Birth (individual)

Business Phone

(

)

Street or PO Box
Business Fax (optional)

(
State

City

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)

(As

Business Mailing Address

 Yes  No

SECTION E - VESSEL OWNER
given on USCG Form 1270 or State Vessel Registration)

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

Last

)

First

Middle Name

 Is this a change of address?

Tax Identification Number (TIN)

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)

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)

 Yes  No

OMB Control No. 0648-0203; Expiration Date:

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.
Signature of Current Permit Owner

Printed Name of Current Permit Owner

Date

re

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. Some of the
information collection described above is confidential under section 402(b) of the Magnuson-Stevens Act. It is also confidential under NOAA Administrative Order 216100, Protection of Confidential Fisheries Statistics. Phone number, fax and email information and TIN are not released to the public. The permit sale/lease information
and the amount of sablefish landed to date given on a transfer form are considered confidential. Similarly, the names associated with a entity that owns a sablefish
permit or has vessel registered to sablefish endorsed permit are confidential, as are date of birth for an individual and any medical records provided to obtain an
exemption from the owner on board required.
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.

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