Vessel ownership form

National Marine Fisheries Service / Northeast Regional Office 
Marine Fisheries Service / Northeast Regional Office 

Vessel Ownership Form 
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Completion of this form is required with each application for a Northeast Federal fishing permit. 
   
List all persons and entities who have an ownership interest in the vessel that is the subject of this 
application. 
 

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Owners or persons who have an ownership interest in a vessel are defined as and include, but are not 
limited to, corporations, partnerships, LLCs, persons who are shareholders in a corporation, persons 
who have formed a partnership (general or limited), and any other entities that have ownership 
interest in the vessel.   

Section A – Vessel applying for permit 
Vessel Name: 

Permit or Hull Number: 

 

Section B ‐ All persons and entities that have an ownership interest in the vessel must be listed below.  Do not 
include employees of the business unless they are an owner of the vessel or company. 
Mr/Mrs/Ms

First Name

Check all that apply -

Mr/Mrs/Ms

Owner

First Name

Check all that apply -

Mr/Mrs/Ms

Middle Name

Middle Name

Owner

First Name

Check all that apply -

Officer

Officer

Middle Name

Owner

Officer

Last Name

Suffix Name

Shareholder

Last Name

Suffix Name

Shareholder

Last Name

Suffix Name

Shareholder

 

I, the undersigned, am the owner or legally authorized agent of the owner of the vessel named in Section A above.  I affirm, subject 
to the penalties provided in 18 U.S.C. 1001, that all information that I have given in obtaining this permit is true and correct.   
OMB# 0648‐0202 Expires  04/30/2013 
 

Name of Applicant (print clearly)____________________________________ 
 
Signature of Applicant _________________________________________      Date_____________
Please use the back of this form to provide information on all persons with an ownership interest in the vessel. 

Page 2 ‐ Section B Continued ‐ All persons and entities that have an ownership interest in the vessel must be 
listed below.  Do not include employees of the business unless they are an owner of the vessel or company. 
Mr/Mrs/Ms

First Name

Check all that apply -

Mr/Mrs/Ms

Mr/Mrs/Ms

Owner

Owner

Officer

Middle Name

Owner

First Name

Check all that apply -

Officer

Middle Name

First Name

Check all that apply -

Officer

Middle Name

First Name

Check all that apply -

Mr/Mrs/Ms

Owner

First Name

Check all that apply -

Mr/Mrs/Ms

Middle Name

Officer

Middle Name

Owner

Officer

Last Name

Suffix Name

Shareholder

Last Name

Suffix Name

Shareholder

Last Name

Suffix Name

Shareholder

Last Name

Suffix Name

Shareholder

Last Name

Suffix Name

Shareholder

 

I, the undersigned, am the owner or legally authorized agent of the owner of the vessel named in Section A above.  I affirm, subject 
to the penalties provided in 18 U.S.C. 1001, that all information that I have given in obtaining this permit is true and correct.   
OMB# 0648‐0202 Expires  04/30/2013 
 

Name of Applicant (print clearly)____________________________________ 
 
Signature of Applicant _________________________________________      Date_____________
 
 
Please copy this form as needed to provide information on all persons with an ownership interest in the vessel 
in Section A.