Tilefish IFQ allocation interest declaration form (owner

Tilefish IFQ Allocation Interest Declaration Form

All persons and entities who have an interest in the Tilefish IFQ Allocation Permit that is the subject of this application must list all the other Tilefish IFQ Allocation Permits in which they have an interest. Individuals who have an interest in a Tilefish IFQ Allocation Permit are defined as and include, but are not limited to, individuals, persons who are shareholders or officers in a corporation, persons who have formed a partnership (general or limited), immediate family members of those who hold an interest, and any other entities that have an interest in a Tilefish IFQ Allocation Permit. If a corporation, partnership, or LLC is listed in Section B, shareholders/officers must be identified.

Section A – Individual Applying for a Tilefish IFQ Allocation Permit

Name, Address, and Phone # of Entity: _________________________________________

_________________________________________________________________________

Section B – Holders of Tilefish IFQ Allocation Permit Listed in Section A, and Any other Tilefish IFQ Allocation held.

1. Interest in the Tilefish IFQ Allocation listed in Section A: If you listed a corporation/partnership/LLC in Section A, list Shareholders, Partners, and Officers below. If you listed a person in Section A, list all other persons that have an interest in this IFQ allocation below if they also have, or will apply for, an IFQ allocation permit. 2. Other Interest in Tilefish IFQ Allocations: Provide the Name and Tilefish IFQ Allocation permit number(s) for any other Tilefish IFQ Allocations in which those named in Section B has an interest.
Name	Tilefish IFQ Permit #	Tilefish IFQ Permit #	Tilefish IFQ Permit #
I, the undersigned, am the holder or legally authorized agent of the holder of the IFQ Allocation named in Section A above. I affirm, subject to the penalties provided in 18 USC 1001, that all information that I have given in obtaining this permit is true and correct. Name of Applicant (print clearly)____________________________________ Signature of Applicant _____________________________________ Date_____________

Paperwork Reduction Act Statement

Public reporting burden for this collection of information is estimated to average 5 minutes per declaration, including the time for reviewing 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 the Assistant Regional Administrator, Sustainable Fisheries Division, NOAA National Marine Fisheries Service, 55 Great Republic Drive, Gloucester, MA 01930.

All data will be kept confidential. 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 CONTROL NO.: 0648-0590 Expires: 01/31/2020

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.

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 NMFS permit applicants and renewing holders includes vessel owner contact information and vessel descriptive information. Permi t 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.