ITQ Transer Request Form

Request for Atlantic
Surfclam or Ocean
Quahog ITQ Allocation
or Cage Tag Transfer

UNITED STATES DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric Administration

NATIONAL MARINE FISHERIES SERVICE
NORTHEAST REGION
One Blackburn Drive
Gloucester, MA 01930-2298

Section 1. Check which type of transfer you are requesting:
Permanent ITQ Allocation Transfer
Temporary Cage Tag Transfer

Section 2.
Transferer (Seller)
Allocation Number:

Name:

Cage Tags to be Transferred
Beginning Tag Number
Ending Tag Number

Total Tags

Tag Series 1:
Tag Series 2:
Tag Series 3:
Section 3.
Transferee (Buyer)
*Allocation Number:

Name:

List of allocation numbers in which an interest is
owned:

* If an allocation number has not been issued
Section 4 of this form must be completed. NMFS
will issue an allocation number upon receipt of the
completed application.

Section 4.
Name:
Vessel (if applicable):
Street:
City/ State/ Zip:
Telephone:
U.S. citizen requirement. By checking this box you are indicating that you are
eligible to own a documented vessel under the terms of 46 U.S.C. 12102(a) and
are able to provide documentation attesting to such eligibility if requested by the
National Marine Fisheries Service.
Section 5.
Signature of Transferer or Authorized Agent:

Signature of Transferee or Authorized Agent:

Date:

Date:

Public reporting burden for this collection of information is estimated to average 5 minutes per response,
including time for reviewing instruction, searching existing data sources, gathering and maintaining data
needed, and completing and reviewing the information. Send comments regarding this burden estimate to: NMFS,
One Blackburn Drive, Gloucester, MA 01930. 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.
OMB Approval No. 0648-0240

Expires 12/31/2008