Limited Entry Drift Gillnet Permit Change of Vessel, Per

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National Marine Fisheries Service
West Coast Region, Long Beach Fisheries Permits Office
501 W Ocean Blvd., Suite 4200
Long Beach, CA 90802
[email protected]

OMB Control No. 0648-0204
Expires XX/XX/20XX

Limited Entry Drift Gillnet Permit
Change of Vessel, Permit Holder, or Vessel Owner Form
Please print legibly. All fields required unless noted otherwise.

SECTION A - ACTION(S) REQUESTED
Transfer of permit owner (Fill out Sections B, C, D, E, F, G a& b)
Permit holders must have held a LE DGN permit for at least three years to meet transfer eligibility requirements.
Change in vessel assigned to permit (Fill out Sections B, C, D, Ga)
Permit holders are allowed to change vessels once ever year (April 1 - March 31).
Change in vessel owner (Fill out Sections B, C, F, Ga)
Attach a copy of the Coast Guard Vessel documentation or State Vessel Registration identifying new ownership.

SECTION B - CURRENT PERMIT HOLDER

Permit Number

Current Vessel Name*

USCG Doc or State Registration Number

Current Permit Owner Name

Tax Identification Number (TIN)

Street or PO Box

Date of Birth

City, State

Zip Code

Phone

Alternate Phone (optional)

Fax (optional)

Email (optional)
*A vessel must be assigned to a permit prior to fishing.

SECTION C - VESSEL OWNER

Current Vessel Owner Name (First, Last, MI) or Business Name)

Tax Identification Number (TIN)

Street or PO Box

Date of Birth (if individual)

City, State

Zip Code

Phone

Alternate Phone (optional)

Email (optional)

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Fax (optional)

SECTION D - CHANGE IN VESSEL ASSIGNED TO PERMIT
NEW vessel name*

USCG or State Vessel Registration Number

CURRENT vessel name

USCG or State Vessel Registration Number

*For the new vessel, submit a copy of the US Coast Guard "Certificate of Documentation" or state vessel registration certificate.

SECTION E - CHANGE OF PERMIT HOLDER

New DGN LE Permit Holder Name**

Tax Identification Number (TIN)

Street or PO Box

Date of Birth

City, State

Zip Code

Phone

Alternate Phone (optional)

Fax (optional)

Email (optional)

*A vessel must be assigned to a permit prior to fishing.

SECTION F - CHANGE OF VESSEL OWNER

New Vessel Owner Name (First, Last, MI) or Business Name)

Tax Identification Number (TIN)

Street or PO Box

Date of Birth (if individual)

City, State

Zip Code

Phone

Alternate Phone (optional)

Fax (optional)

Email (optional)

SECTION G - SIGNATURE(S)
a. Current Permit Owner (Transferor): Under penalty of perjury, I hereby declare that I, the undersigned, am the current permit holder
and certify that this permit transfer and the information contained herein is true, correct, and complete to the best of my knowledge.
Printed Name
Signature
Date

b. New Permit Owner or Owner of Vessel Registered to the Permit (Transferee): Under penalty of perjury, I hereby declare that I,
the undersigned, am the current permit holder and certify that this permit transfer and the information contained herein is true, correct,
and complete to the best of my knowledge.
Printed Name
Signature
Date

MAIL COMPLETED FORM AND REQUIRED DOCUMENTS TO:
NMFS PERMITS OFFICE, 501 W OCEAN BLVD., SUITE 4200, LONG BEACH, CA 90802
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INSTRUCTIONS

MAIL COMPLETED APPLICATION AND REQUIRED DOCUMENTS TO:
NMFS PERMITS OFFICE, 501 W OCEAN BLVD., SUITE 4200, LONG BEACH, CA 90802
SECTION A - ACTION(S) REQUESTED: Please check the box next to the action(s) requested. Fill out the sections
listed for each action.
SECTION B - CURRENT PERMIT HOLDER: Please provide the permit holders contact information and the vessel
information that this permit is assigned to. If no vessel is assigned, indicate “unidentified” for vessel name. In
addition, provide the permit holders name (vessel operator) as given on the current permit and the Tax
Identification Number (TIN) and date of birth (DOB).
If assigning a vessel during a permit period (April 1 - March 31), the permit holder is required to notify the permits
office (mail, fax, e-mail) and submit a copy of the current Coast Guard documentation or state registration. NMFS
may request additional information if necessary. A vessel must be assigned to the permit prior to fishing.
SECTION C - CURRENT VESSEL OWNER: Please provide the vessel owners name, address, phone number, TIN (if
business) or DOB (if individual), and vessel information. If no vessel is assigned, indicate “unidentified" for vessel
owner name.
SECTION D - CHANGE IN VESSEL ASSIGNED 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/number to be
registered to the permit. The new vessel name/number will appear on the reissued permit. Include a copy of the
Coast Guard documentation or state registration for the new vessel.
SECTION E - CHANGE OF PERMIT HOLDER: Please provide the new permit owner's name, contact information, Tax
Identification Number (TIN) and date of birth.
SECTION F - CHANGE OF VESSEL OWNER: If registering a new vessel to the permit or if the vessel owner has
changed, please provide the name of the vessel with Coast Guard documentation number or state registration
number, contact information, Tax Identification Number (TIN), and birth date (if individual). Provide a copy of the
Coast Guard Vessel documentation or State Vessel registration that identifies the new ownership.
SECTION G - SIGNATURE(S): a. Either current permit owner or an authorized representative of the permit owner
must sign and date the form. 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. b. This requires that both transferor and transferee sign and date the form to
confirm that both parties agree on the permit transfer.

This information collected is part of a Privacy Act System of Records, COMMERCE/NOAA #19, Permits and
Registrations for United States Federally Regulated Fisheries. An amended notice was published in the Federal
Register on August 7, 2015 (80 FR 47457) and became effective on September 15, 2015 (80 FR 55327).

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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.
PAPERWORK REDUCTION ACT - Public reporting burden for this collection of information is estimated to average
0.5 hours 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
PRIVACY ACT STATEMENT Authority: The collection of this information is authorized under the Magnuson-Stevens Fishery Conservation and
Management Act, 16 U.S.C 1801 et seq., the High Seas Fishing Compliance Act, the Tuna Conventions Act of 1950,
the Antarctic Marine Living Resources Convention Act, the Western and Central Pacific Fisheries Convention
Implementation Act (WCPFCIA; 16 U.S.C. 6901 et seq), the Marine Mammal Protection Act, the Endangered Species
Act and the Fur Seal Act. The authority for the mandatory collection of the Tax Identification Number (TIN) is 31
U.S.C. 7701.
Purpose: In order to manage U.S. fisheries, the NOAA National Marine Fisheries Service (NMFS) requires the use of
permits or registrations by participants in the United States. Information on NOAA Fisheries permit applicants and
renewing holders includes vessel owner contact information, date of birth, TIN and vessel descriptive information.
Permit holder information may be used as sampling frames for surveys, as part of Fishery Management Council
(FMC) analysis to support FMC decisions.
Routine Uses: The Department will use this information to determine permit eligibility and to identify fishery
participants. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a), to be
shared within NMFS offices, in order to coordinate monitoring and management of sustainability of fisheries and
protected resources, as well as with the applicable State or Regional Marine Fisheries Commissions and
International Organizations. Disclosure of this information is also subject to all of the published routine uses as
identified in the Privacy Act System of Records Notice COMMERCE/NOAA-19, Permits and Registrations for the
United States Federally Regulated Fisheries.
Disclosure: Furnishing this information is voluntary; however, failure to provide complete and accurate
information will prevent the determination of eligibility for a permit.

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