Trawl Identification of Ownership Interest Form

OMB Control No. 0648-0620; Expires 1/31/2026

TRAWL IDENTIFICATION OF
OWNERSHIP INTEREST FORM

PACIFIC COAST GROUNDFISH
TRAWL RATIONALIZATION PROGRAM

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National 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
This form must be completed and submitted to the National Marine Fisheries Service (NMFS) at the address given
above to provide ownership information for individuals or businesses applying for or renewing: a quota share (QS)
permit and account, a vessel account, a mothership (MS) permit, or a mothership catcher vessel (MS/CV) endorsed
limited entry permit. Ownership interest information will assist NMFS in determining compliance with accumulation
limits for ownership and control under the trawl rationalization program. Any individual or business applying for or
renewing any of the above permits, accounts, or endorsements must document those individual persons that have
an ownership interest in the amount of greater than or equal to 2 percent.
Please type or print legibly in ink. Attach additional sheets as necessary. Sign in ink, keep a copy for your records
and mail the completed form to the address listed above.
Section A – Permit or Vessel Owner Identification
•

Field 1. Permit Number or Vessel Name and USCG or State Registered Vessel Number: If you are
submitting an ownership interest form with an application or renewal for a QS permit and account, or a
renewal for an MS permit or MS/CV endorsed limited entry permit, list the permit number. If you are
submitting an ownership interest form with an application or renewal for a vessel account, please provide
the name of the vessel and its USCG or state registered vessel number.

•

Fields 2-3. Legal Name of Permit or Vessel Owner and TIN or DOB: Enter the name of the business entity
or individual that owns the permit or vessel. If a business entity, list tax identification number (TIN). If an
individual person, list date of birth (DOB) using the format mm/dd/yyyy.

•

Field 4. State Registered In (if business): If a business entity, list the state where that entity was established
and is currently recognized as active.

•

Field 5. Business Mailing Address: Enter the business mailing address, including street or PO Box number,
city, state, and zip code where the item(s) should be sent. This information should match the information
provided on the application or renewal form.

•

Field 6-8. Business Phone/Fax/Email: List the business telephone and fax numbers, including area codes.
This information should match the information provided on the application or renewal form.

Section B – Identification of Shareholders and Partners
The intent of Section B (Parts 1 and 2) is to identify all of the individuals who control the business and their percent
of ownership interest. Use as many pages as needed to list each entity down to the individual level. Please note
that only ownership interest for shareholders with greater than or equal to 2% ownership interest in the business
entity must be reported.
•

Part 1 – first level
Part 1 must be filled with the business entities or individuals listed in Section A. List the TIN for business
entities and the date of birth (DOB) for individuals. List the mailing address (if different than Section A),
and the % ownership interest in the permit as listed in Section A. Please see examples below.

Trawl Identification of Ownership Interest Form - Page 1 of 7

•

Part 2 – second level
If Part 1 included any business entities, Part 2 should be completed. For example, if Part 1 listed a business
entity and an individual, only the business entity would need to be entered into Part 2. If the business entity
is able to be listed to the individual level in Part 2, no further identification is needed. However, if Part 2
includes a business entity, you will need to list this ownership behind this entity. All business entities owning
2% or greater interest in the permit or vessel must be listed to the individual level. Please see examples
below and print additional pages and write in “third level”, “fourth level”, etc. if needed.

Example A: jointly named owners, two individuals

Part 1

Part 2
%
HELD

TIN/DOB

Ahab,
Captain R

05/15/1959

1234 Petrale St,
Astoria, OR 54321

75

Starbuck,
Jim T

10/23/1963

PO Box 555,
Newport, OR 54123

25

TOTAL OWNERSHIP =

100%

DOB

NAME

BUSINESS MAILING
ADDRESS

%
HELD

business name from Part 1

List individual names

BUSINESS MAILING
ADDRESS

NAME

TOTAL OWNERSHIP =

%

Example B: jointly named owners, an individual and a business

Part 2
Part 1

Dragger,
Joe A
Trawlers,
Inc.

TIN/DOB

BUSINESS MAILING
ADDRESS

05/15/1959

3 Dover Lane
Astoria, OR 54321

91-1234567

PO Box 70,
Newport, OR 54123

TOTAL OWNERSHIP =

NAME

DOB

BUSINESS
MAILING ADDRESS

%
HELD

business name from Part 1

Trawlers, Inc.
50%
Ahab, Captain R

05/15/1959

1234 Petrale St,
Astoria, OR 54321

55%

Starbuck, Jim T

10/23/1963

PO Box 555,
Newport, OR 54123

30%

Ishmael, Mark S

03/07/1965

8 White Whale Dr.
Newport, OR 54123

10%

Queequeg,
Warren G

07/23/1968

13 Wildside Blvd.
Astoria, OR 54321

3%

50%

100%

List individual names

NAME

%
HELD

TOTAL OWNERSHIP of Business 1 =

Trawl Identification of Ownership Interest Form - Page 2 of 7

100%

Example C: jointly named owners, two businesses

Part 2

Part 1
NAME

TIN/DOB

BUSINESS MAILING
ADDRESS

%
HELD

NAME

DOB

BUSINESS
MAILING ADDRESS

%
HELD

business name from Part 1

91-1234567

PO Box 70,
Newport, OR 54123

30%

Big Boat,
LLC

71-7654321

4 Ever Whiting
Astoria, OR 54321

70%

TOTAL OWNERSHIP =

100%

Trawlers, Inc.

List individual names

Trawlers,
Inc.

Ahab, Captain R

05/15/1959

1234 Petrale St,
Astoria, OR 54321

55%

Starbuck, Jim T

10/23/1963

PO Box 555,
Newport, OR 54123

30%

Ishmael, Mark S

03/07/1965

8 White Whale Dr.
Newport, OR 54123

10%

Queequeg,
Warren G

07/23/1968

13 Wildside Blvd.
Astoria, OR 54321

5%

TOTAL OWNERSHIP of Business 1 =

100%

business name from Part 1

List individual names

Big Boat, LLC
Hake, Jim C

06/03/1950

4 Ever Whiting
Astoria, OR 54321

331/3%

Hake, Brenda K

08/30/1954

4 Ever Whiting
Astoria, OR 54321

331/3%

Hake, Jr., Jim C

11/23/1975

12 Ever Whiting
Astoria, OR 54321

331/3%

TOTAL OWNERSHIP of Business 2 =

Section C – Small Business Certification
Read the information to determine if you are a small business according to the criteria listed. Check the appropriate
box, yes or no.
Section D – Certification of Applicant
The applicant or authorized representative must sign and date the form. By signing and dating the form, the
applicant or authorized representative certifies that all information set forth in the form is true, correct and complete
to the best of the applicant’s knowledge or belief. The form will not be considered without the authorized
representative’s signature. NMFS may request that the authorized representative for a business entity include a
copy of the corporate resolution or other document authorizing the individual to sign and certify on behalf of the
business entity.

Trawl Identification of Ownership Interest Form - Page 3 of 7

100%

OMB Control No. 0648-0620; Expires 1/31/2026

TRAWL IDENTIFICATION OF
OWNERSHIP INTEREST FORM

PACIFIC COAST GROUNDFISH
TRAWL RATIONALIZATION PROGRAM

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration
National 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

Section A – Permit or Vessel Owner Identification
1. Permit Number

Vessel Name

USCG or State Registered Vessel Number

or
2. Legal Name of Permit or Vessel Owner

3. TIN (if business) or DOB (if person)

4. State Registered In (if business)

5. Business Mailing Address

6. Business Phone Number

Street or PO Box
7. Business Fax Number (optional)

City

State

Zip Code

8. Business Email

Section B – Identification of Shareholders and Partners
Part 1 – First Level
NAME
(Last, First, Middle Initial)

TIN or DOB

BUSINESS MAILING ADDRESS
(Street or PO Box, City, State, Zip Code)

TOTAL OWNERSHIP =

Trawl Identification of Ownership Interest Form - Page 4 of 7

% INTEREST
HELD

%

Section B – Identification of Shareholders and Partners
Part 2 – Second Level
NOTE: Owners of a business entity from Section B – Part 1 above must be listed down to the level of individual persons that make
up that business. If more than one business is listed, be clear which individuals belong to which business. If necessary, attach an
additional sheet of paper with the information required below.
NAME
(Last, First, Middle Initial)

TIN or DOB

BUSINESS MAILING ADDRESS
(Street or PO Box, City, State, Zip Code)

% INTEREST
HELD

Business Name 1 from Part 1

TOTAL OWNERSHIP OF BUSINESS 1 =

%

TOTAL OWNERSHIP OF BUSINESS 2 =

%

TOTAL OWNERSHIP OF BUSINESS 3 =

%

Business Name 2 from Part 1

Business Name 3 from Part 1

Trawl Identification of Ownership Interest Form - Page 5 of 7

Section C – Small Business Certification

As part of required analyses of the economic effects of rulemakings, The National Marine Fisheries Service
(NMFS) must determine if permit and license owners participating in the fishery are large or small businesses
as defined by the Small Business Administration (SBA).
SBA has established size criteria for all major industry sectors in the US, including fish harvesting and fish
processing businesses. The SBA also has established "principles of affiliation" to determine whether a
business concern is "independently owned and operated": business concerns are affiliates of each other when
one concern controls or has the power to control the other, or a third party controls or has the power to control
both. NMFS is now using the following size standards:
Primary
Business:
Small
business
size
standard:

Fish Harvesting

Combined annual
receipts of $11
million or less for
all affiliated
operations
worldwide.

Seafood Product
Preparation and
Packaging *

Fish and Seafood
Wholesale

Employs 750 or fewer
persons on a full time,
part time, temporary, or
other basis, at all
affiliated operations
worldwide.

Employs 100 or fewer
persons on a full time,
part time, temporary, or
other basis, at all
affiliated operations
worldwide.

Nonprofit Organizations **

Environmental, conservation, or
professional organizations:
Combined annual receipts of $15
million or less.
Other organizations:
Combined annual receipts of $7.5
million or less.

*includes catcher/processors and motherships
**SBA size standards for nonprofits to inform whether the organization is "dominant in their field of operation"

Is your business or organization:
-

Independently owned and operated, and
not dominant in its field of operation (including any affiliates), and
considered small by the standards listed in the table above?

Trawl Identification of Ownership Interest Form - Page 6 of 7

Section D – Certification of Applicant
Under penalties of perjury, I hereby declare that I, the undersigned, am authorized to certify this application on behalf of the applicant and
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

Date

Printed Name of Authorized Representative

WARNING STATEMENT: A false statement on this form is punishable by permit sanctions (revocation, suspension, or modification) under 15
CFR Part 904, a civil penalty up to $100,000 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: 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. TIN or DOB, business phone
number, fax number, and email 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 are not released to the
public. The 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).

PRA STATEMENT: Public reporting burden for this collection of information is estimated to average 0.75 hours per response for new entrants,
and is estimated to average 5 minutes when pre-filled for renewing entities, 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 suggestions for reducing this burden to NOAA/National Marine Fisheries Service, West Coast Region, Attn:
Program Manager, Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115. Notwithstanding any other provisions of the
law, no person is required to respond to, nor shall any person be subjected 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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