HMS permit renewal application, completely prefilled

Expiration Date

PERMIT APPLICATION FEE: $30

UNITED STATES DEPARTMENT OF COMMERCE

National Oceanic and Atmospheric Administration

NATIONAL MARINE FISHERIES SERVICE

West Coast Region

501 West Ocean Blvd, Suite 4200

Long Beach, CA 90802

OMB#: 0648-0204

APPROVAL EXPIRES: 08/31/2016

Pacific Highly Migratory Species

Vessel Permit Renewal Application

Please write-in any changes or corrections

VESSEL INFORMATION
USCG Documentation or State Registration Number
Vessel Name
Home Port and State						Hail Port and State
Radio Call Sign						VMS
Registered Length (Ft.)			Registered Breadth (Ft.)				Registered Depth (Ft.)
Gross Tons			Net Tons				CFPV Passenger Cap.
Hold Capacity (Short tons, 1 ST= 2,000 lbs.)
Refrigeration Type				Propulsion Type				Horsepower
Hull Material
Year Built		Location Built						Crew Size
Previous Vessel Name/Flag/Effective Dates
Gear Type Authorized by the HMS Permit (Addition of gear types may be subject to further authorization)

VESSEL OWNERSHIP INFORMATION
Permit Holder and/or Company Name
Business Mailing Address
Business Telephone		Fax		Mobile
Email Address
Additional Owners/Birthdate (if new)

SIGNATURE

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

Name (Print legibly) Signature Date

___________________________________ _________________________________ ____________

Permit application fee: $30.00 payable to “US Department of Commerce – NOAA”

Mail to: Permits Office, 501 W Ocean Blvd. Suite 4200, Long Beach, CA 90802