Change of Vessel Registration and Permit Owner Applicati

OMB Control No. 0648-0203; Expires XX/XX/20XX

OMB 0648-0203 Expires 09/30/09

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 N ational Marine Fisheries Service, West Coast Region Fisheries Permits Office 7600 Sand Point Way NE, Bldg. 1 Seattle, WA 98115-0070 Phone (206) 526-4353 Fax (206) 526-4461 www.westcoast.fisheries.noaa.gov

INSTRUCTIONS

REMINDER: Please provide your current limited entry permit with the completed transfer request form.

SECTION A - ACTION(S) REQUESTED: Please check the box next to the action(s) requested. Fill out the sections listed for each action. If multiple permits are being combined to either increase the size endorsement or to stack (sablefish-endorsed only), a separate form must be completed for each permit. For actions that include a change in vessel registered to a sablefish-endorsed permit, there are three sub-actions that can be taking place (stacking, moving, or removing). If you are registering a vessel to the permit, you must complete Section E.

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.”

NOTE: If you are changing a permit owner or vessel registration on a sablefish endorsed permit during the primary season, the applicant must complete Section F.

SECTION B - CURRENT PERMIT OWNER: List 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. Enter Tax Identification number (TIN) and/or date of birth (DOB) of the current permit owner(s). This section must be signed by an authorized representative for business entities or all permit owner(s) required to sign for NMFS to implement the designated actions (See NOTE 1 below). A signed and dated corporate resolution or other such document may be required from business entities authorizing an individual to sign the form on behalf of the corporation/partnership. The current permit owner(s) or authorized permit owner(s) must sign and date the application. By signing and dating the application, the applicant certifies that all information set forth in the application is true, correct, and complete to the best of the applicant’s knowledge and belief. For sablefish endorsed permits, if the permit owner is a business entity, an ownership interest form must be submitted.

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, SSN/TIN, signatures, date of signature, and notarize the separate sheet. Note the Privacy Act Statement at the end of the application.

SECTION C - CHANGE OF VESSEL REGISTERED TO PERMIT: If you are changing the vessel registered to the permit, please indicate the name and registration number of the current vessel listed on the permit on the left side of Section C and list the name and registration number of the new vessel on the right side of Section C. 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. A recent marine survey (conducted in last 3 years) must be provided for a vessel not currently registered to a limited entry permit to verify its length overall.

SECTION D - NEW PERMIT OWNER: List each new permit owner’s name(s), a business address and phone number. Enter the Tax Identification number (TIN) (if business entity) date of birth (for an individual) for the 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 provide permit owner names and TIN or date of birth. Note the Privacy Act Statement at the end of the application.

SECTION E - VESSEL OWNER: Please provide the name of the owner(s) of the vessel to be registered to the permit as given on the U.S. Coast Guard Certificate of Documentation or state vessel registration document. Please provide the individual(s) or business name, business address and phone number. If the vessel owner is different from the listed permit owner, enter the Tax Identification number (TIN) and/or date of birth (DOB). If the space provided in this section is not adequate to list all owners, 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 TRANSFER: Fill out this section if you are requesting a transfer of a sablefish-endorsed permit at any time during the primary sablefish season. This section requires the transferor to certify the cumulative amount of sablefish landings for the current primary sablefish season on the permit at the time of transfer and requires the transferee to acknowledge the amount of sablefish the cumulative amount of sablefish landings on the permit to date. In the case of an enforcement investigation on a sablefish-endorsed permit, the transferor may be held liable for certifying false landings during a mid-season transfer of a permit.

Eligibility to own or hold a Pacific Coast Groundfish Limited Entry Permit:

Persons eligible to own a documented vessel are:

• an individual who is a citizen of the United States
  

• an association, trust, joint venture or other entity -

a) all of whose members are citizens of the United States; and

b) that is 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;

Please mail this application with your current limited entry permit and other required supporting documentation to the address listed at the top of the instructions page.

Change of Vessel Registration Permit Owner or Vessel 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

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 (Fill out Sections B, D & F)

SECTION B - CURRENT PERMIT OWNER

Permit Number GF

Vessel Name

USCG Doc or State Registration Number

Current Permit Owner Name(s) (Last, First, Middle Name or Business Name) Business Name			Tax Identification Number (TIN) (For each corporate or business entity)
Last	First	Middle Name	Date of Birth (For each individual)

Business Mailing Address  Is this a change of address?			Business Phone ( )
Street or PO Box
			Business Fax (optional) ( )
City	State	Zip Code	Business Email (optional)

Permit Owner Certification
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.
Signature of Applicant or Authorized Representative	Date
Printed Name of Signee Above

CURRENT Vessel Name:

NEW Vessel Name

NEW Vessel Name:

USCG Doc or State Registration Number

USCG Doc or State Registration Number

Length Overall feet

Length Overall feet

SECTION C - CHANGE OF VESSEL REGISTERED TO PERMIT

For the new vessel, submit a copy of the US Coast Guard “Certificate of Documentation” (CG-1270) or the registration certificate issued by a state. Also submit a marine survey documenting vessel length overall (LOA). The survey must be conducted by a certified marine surveyor according to the USCG method for determining LOA.
SECTION D - NEW PERMIT OWNER
New Permit Owner Name(s) (Last, First, Middle Name or Business Name) Business Name			Tax Identification Number (TIN) (For each corporation or business entity)
Last	First	Middle Name	Date of Birth (For each individual)
Business Mailing Address  Is this a change of address?			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)  yes  no

SECTION E - VESSEL OWNER (As given on USCG Form 1270 or State Motorboat License)
Permit Holder/Vessel Owner Name(s) (Last, First, Middle Name or Business Name)		TIN (If multiple owners, attach a list of their names and TIN)

Last

First

Middle Name

DOB (If multiple owners, attach a list of their names and DOB)

Business Mailing Address  Is this a change of address?			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)  yes  no

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. re
Printed Name of Current Permit Owner	Signature of Current Permit Owner	Date

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 30 minutes 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 216-100, 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) The 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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