Amendment 80 cooperative permit and cooperative quota ap

Revised: 12/19/2013 OMB Control No. 0648-0565 Expiration Date: 01/31/2016

Amendment 80 Cooperative Quota (CQ) Permit		U .S. Dept. of Commerce/NOAA National Marine Fisheries Service (NMFS) Restricted Access Management (RAM) P.O. Box 21668 Juneau, AK 99802-1668
A Cooperative Quota (CQ) permit is issued annually to an Amendment 80 cooperative that submits a complete and timely application for CQ and each member of the Amendment 80 cooperative holding Amendment 80 Quota Share (QS) has submitted an Amendment 80 Economic Data Report as described under § 679.94 that is subsequently approved by the Regional Administrator. ATTACHMENT: A copy of the cooperative membership agreement or contract must be provided with this application.
This application must be submitted annually and received by NMFS no later than 1700 hours A.l.t. on November 1 of the year prior to the year for which the applicant wishes to participate in an Amendment 80 fishery, or if sent by U.S. mail, the application must be postmarked by that time.
BLOCK A – AMENDMENT 80 COOPERATIVE IDENTIFICATION
1. Cooperative's legal name		2. Type of business entity under which the Amendment 80 Cooperative is organized
		3. State in which the Amendment 80 Cooperative is legally registered as a business entity
4. Permanent business address
5. Business telephone number	6. Business fax number	7. E-mail address (if available)
8. Printed name of Amendment 80 Cooperative’s Designated Representative

BLOCK B – MEMBERS OF THE AMENDMENT 80 COOPERATIVE
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full name	2. NMFS Person ID
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full name	2. NMFS Person ID
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full name	2. NMFS Person ID
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)

Amendment 80 QS Permit Holder and Ownership Documentation
1. Full name	2. NMFS Person ID
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full name	2. NMFS Person ID
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)
Amendment 80 QS Permit Holder and Ownership Documentation
1. Full name	2. NMFS Person ID
	3. Amendment 80 QS Permit Number(s)
Enter the names of all persons, to the individual level, holding an ownership interest in the Amendment 80 QS permit(s) assigned to the Amendment 80 cooperative and the percentage ownership each person and individual holds in the Amendment 80 QS permit(s).
Name	% Ownership in Amendment 80 QS Permit(s)

BLOCK C – IDENTIFICATION OF AMENDMENT 80 COOPERATIVE MEMBER VESSELS AND AMENDMENT 80 LLP LICENSES
Vessel Name	ADF&G No./USCG documentation number	Amendment 80 LLP license number

BLOCK D -- IDENTIFICATION OF VESSELS ON WHICH THE CQ ISSUED TO THE AMENDMENT 80 COOPERATIVE WILL BE USED
Vessel name	ADF&G No./ USCG documentation number

BLOCK E -- EDR SUBMISSION

Has each member of the Amendment 80 cooperative submitted a timely and complete EDR for each Amendment 80 QS permit held by that person as required under § 679.94?

[__] YES [__] NO

BLOCK F – CERTIFICATION OF COOPERATIVE AUTHORIZED REPRESENTATIVE
The Cooperative Authorized Representative must sign and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. Attach explicit authorization to complete the application on behalf of the members of the cooperative.
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, the information presented here is true, correct, and complete.
1. Signature of Cooperative Authorized Representative	2. Date Signed
3. Printed Name of Cooperative Authorized Representative

Application for Amendment 80

Cooperative Quota (CQ) Permit

This completed application must be received by NMFS no later than 1700 hours A.l.t. on November 1 of the year prior to the year for which the applicant wishes to participate in an Amendment 80 fishery, or if sent by U.S. mail, the application must be postmarked by that time.

A CQ permit authorizes an Amendment 80 cooperative to participate in the Amendment 80 Program. NMFS will issue a CQ permit annually to an Amendment 80 cooperative if that Amendment 80 cooperative has:

♦ Submitted a complete and timely application for CQ;

♦ Each member of the Amendment 80 cooperative holding Amendment 80 QS has submitted an Economic Data Report as described under § 679.94 that is subsequently approved by the Regional Administrator.

♦ An Amendment 80 CQ Permit is valid under the following circumstances:

Until the end of the year for which the Amendment 80 limited access fishery permit is issued;

Until the Amendment 80 limited access fishery is closed by the Regional Administrator; or

Until the permit is revoked, suspended, or modified pursuant to § 679.43 or under

15 CFR part 904.

♦ A legible copy of the Amendment 80 CQ Permit must be carried on board the Amendment 80 vessels assigned to the Amendment 80 Cooperative.

♦ A copy of the cooperative membership agreement or contract is provided with this application.

This application cannot be processed or approved unless each member of the Amendment 80 cooperative has submitted a timely and complete Amendment 80 Economic Data Report (EDR) for each Amendment 80 QS permit held by that person.

The annual EDR submission deadline is June 1.

To request that a printed EDR be mailed to you (at no cost), contact

Pacific States Marine Fisheries Commission

205 SE Spokane, Suite 100

Portland, OR 97202

Telephone: 1-877-741-8913

e-mail: info@psmfc.org

If the Amendment 80 QS Permit Holder is a non-individual (i.e., a corporation, partnership or other entity), provide the names of, and the percentage of ownership held by, all of its owners. Information should be provided to the individual level. See example below:

Name of Owner	% Interest
Joe Potpuller	25%
Alice Potpuller	25%
LLP Family Holdings, Inc.	50%
C. A80QSholder	25% (of 50%)
R. A80QSholder	25% (of 50%)
A. A80QSholder	25% (of 50%)
B. A80QSholder	25% (of 50%)

Duplicate the form, or attach a separate sheet of paper if necessary to display all of the Applicant’s owners (and owners of the Applicant’s owners to the individual level).

Type or print legibly in ink; retain a copy of completed application for your records.

When application is complete, submit

By mail to: NMFS Alaska Region

Restricted Access Management

P.O. Box 21668

Juneau, AK 99802-1668

By Fax to: (907) 586-7354

Submit Electronically: http://alaskafisheries.noaa.gov

If you need additional information, contact Restricted Access Management (RAM) as follows:

Website: http://www.alaskafisheries.noaa.gov/ram/default.htm

Telephone (toll free): 800-304-4846 (press “2”)

Telephone (in Juneau): 907-586-7202 (press “2”)

e-Mail: RAM.Alaska@noaa.gov

Please allow at least 10 working days for your application to be processed. Items will be sent by first class mail, unless you provide alternate instructions and include a prepaid mailer with appropriate postage or corporate account number for express delivery.

COMPLETING THE APPLICATION

BLOCK A -- AMENDMENT 80 COOPERATIVE IDENTIFICATION

1. Cooperative's legal name

2. Type of business entity under which the Amendment 80 Cooperative is organized.

Each Amendment 80 cooperative must be formed as a partnership, corporation, or other legal business entity that is registered under the laws of one of the 50 states or the District of Columbia;

3. State in which the Amendment 80 Cooperative is legally registered as a business entity

4. Permanent business address

5. Business telephone number, business fax number, and e-mail address (if available)

6. Printed name and signature of Amendment 80 designated representative and date signed

BLOCK B – MEMBERS OF THE AMENDMENT 80 COOPERATIVE -- Amendment 80 QS Permit Holder and Ownership Documentation (complete for all members of the Amendment 80 cooperative)

1. Full name

2. NMFS Person ID

3. Amendment 80 QS Permit Number(s)

4. Names of all persons, to the individual level, holding an ownership interest in the

Amendment 80 QS Permit Number(s) assigned to the Amendment 80 cooperative

5. The percentage ownership each person and individual holds in the Amendment 80 QS Permit(s).

BLOCK C – IDENTIFICATION OF AMENDMENT 80 COOPERATIVE MEMBER VESSELS AND AMENDMENT 80 LLP LICENSES

Identify the Amendment 80 vessels by name, Alaska Department of Fish & Game (ADF&G) vessel registration No., United States Coast Guard (USCG) documentation number, and the Amendment 80 License Limitation Program (LLP) licenses held by all members of the Amendment 80 Cooperative.

BLOCK D -- IDENTIFICATION OF VESSELS ON WHICH THE CQ ISSUED TO THE AMENDMENT 80 COOPERATIVE WILL BE USED

Identify the Amendment 80 vessels by name, ADF&G vessel registration number, and USCG documentation number on which the CQ issued to the Amendment 80 Cooperative will be used.

BLOCK E – EDR SUBMITTAL

Indicate (YES or NO) whether the each member of the Amendment 80 cooperative has submitted an Amendment 80 Economic Data Report (EDR) as required under § 679.94.

BLOCK F – CERTIFICATION OF COOPERATIVE AUTHORIZED REPRESENTATIVE

The Cooperative Authorized Representative must print name, sign, and date the application certifying that all information is true, correct, and complete to the best of his/her knowledge and belief. Attach explicit authorization to complete the application on behalf of the members of the cooperative.

Amendment 80 Cooperative Quota Permit

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