Change in registration of a mothership/catcher vessel en

OMB Control No. 0648 -0620; Expiration Date: 11/30/2013

Change in Registration of a
Mothership/Catcher Vessel
Endorsement/Catch History
Assignment 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
Phone (206) 526-4353
www.nwr.noaa.gov
Limited Entry Permit
Section A – Current Permit Registration

Fax (206) 526-4461

MS/CV Endorsement and CHA ID Number

Permit Number

GF0
Current Permit Owner

Last

Tax Identification Number

First

MI

Date of Birth

Business Mailing Address (Street or P.O. Box)

Business Phone Number
(

City

State

Zip Code

)

Business Fax Number
(

)

Section B – New Permit Registration
[identify the new permit that MS/CV endorsement and Catch History Assignment will be registered to]
Permit Number

GF0
Permit Owner Name

Last

Tax Identification Number

First

MI

Business Mailing Address (Street or PO Box)

Date of Birth

Business Phone Number
(

City

State

Zip Code

)

Business Fax Number
(

)

Transaction Price Information for MS/CV endorsement and whiting CHA. (mandatory)
The nature of the transaction was: [ ] Monetary [ ] Non-monetary
If transaction was monetary, please provide the selling price of the listed MS/CV endorsement and CHA: $_________________
If the transaction was non-monetary, please explain the nature of the transaction (i.e.; registered to another that I own or traded
whiting CHA for XX quota pounds of Dover sole): ____________________________________________________________

MS/CV Endorsement and Catch History Assignment Registration Form

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OMB Control No. 0648 -0620; Expiration Date: 11/30/2013

SECTION C – CERTIFICATION AND NOTARY
Under penalties of perjury, I hereby declare that I, the undersigned, am authorized to sign this form on behalf of the applicant and I
completed this form, and the information contained herein is true, correct, and complete to the best of my knowledge and belief.
Signature of Authorized Representative

Printed Name of Authorized Representative (NOTE: attach authorization, if needed)

Notary Public Signature

“ ATTEST

Affix Notary Stamp or Seal Here

Date Commission Expires

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 $140,000 under 16 USC 1858, and/or criminal penalties including, but not limited to, fines or imprisonment or both under 18
USC 1001.
PRIVACY ACT STATEMENT: Your DOB and/or TIN are confidential and protected under the Privacy Act. Provision of your DOB or TIN is mandatory
as part of this collection. The primary purpose for requiring the DOB and/or TIN 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 Registration 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).
PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 2.0 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. Some of the information collection described above is confidential under section 402(b) of the MagnusonStevens Act and under NOAA Administrative Order 216-100, Protection of Confidential Fisheries Statistics. Phone number, fax, email, TIN, and DOB
are not released to the public. The names of individuals who have an ownership interest in an entity that owns a permit, vessel or processing plant and
the actual percentage of ownership are considered business confidential and released to the public.

MS/CV Endorsement and Catch History Assignment Registration Form

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OMB Control No. 0648 -0620; Expiration Date: 11/30/2013

Change in Registration of a
Mothership/Catcher Vessel
Endorsement and Catch History
Assignment 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
www.nwr.noaa.gov

Fax (206) 526-4461

INSTRUCTIONS
In order to request a change in the registration of a Mothership Catcher Vessel (MS/CV)
Endorsement and the associated whiting Catch History Assignment (CHA) from one trawl
endorsed permit to another trawl endorsed permit, the current permit owner must complete and
submit this form to the National Marine Fisheries Service (NMFS) at the address given above.
A separate form must be completed for each individual MS/CV endorsement and CHA being
registered to another trawl permit. The application period is September 1 – December 31 of the
current year. NMFS will not accept any application received after December 31st.
Section A – Current Permit Owner and MS/CV Endorsement and CHA Registration:
Please provide the current Pacific Coast groundish permit number that the MS/CV endorsement
and CHA is registered to and provide the identifier number for the MS/CV endorsement and
CHA unit you wish to transfer. List the permit owner name, business address, business phone
number and fax number of the trawl endorsed permit listed in this Section.
Section B – New Permit Registration: Please provide the number of the Pacific Coast
Groundfish permit that the MS/CV endorsement and CHA will be registered to. List the permit
owner’s name, business address, business phone number and fax number. The applicant must
respond to questions regarding the nature of the transaction involving the MS/CV endorsement
and CHA. If the transaction was monetary in nature, please provide the sale price for the
MS/CV endorsement and CHA. If non monetary, please describe the nature of the transaction.
For example, the transaction might involve a trade of the MS/CV endorsement and CHA for a
specific amount of quota pounds for one or more IFQ species.
Section C – Certification and Notary: An authorized representative must sign and date the
form in the presence of a notary. A registered notary must sign and date this section and affix
notary stamp or seal. By signing and dating the form, the authorized representative certifies
that the information set forth in the form is true, correct and complete to the best of the
applicant’s knowledge and belief. The form will not be considered complete with the athorized
representative’s signature.

MS/CV Endorsement and Catch History Assignment Registration Form

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