Form 01-824www - Vessel License Change Of Information Form printable pdf download

COMMERCIAL FISHERIES ENTRY COMMISSION

STATE OF ALASKA

8800 Glacier Highway, #109, Juneau, Alaska 99801

(907) 789-6150

Vessel License Change of Information Form

INSTRUCTIONS: This form may be used to add or change licensing information for a vessel which is already licensed for the current year. Informa-

tion which may be changed includes: (A) salmon net registration area, (B) salmon troll registration, and (C) owner's name and address. There is no

fee for changing this information, however, the vessel license receipt card for the current year must be submitted along with this form.

The carbon copy of the completed form may be used as a temporary vessel registration ONLY if the bottom section of the form has been signed by

an employee of the Entry Commission, or an employee of the Dept. of Fish and Game or Division of Fish and Wildlife Protection as authorized by the

CFEC.

_______________________________

___________________________________________________

___________________________

ADF&G NUMBER

Vessel Name (check here if this is a new name for vessel _____) Coast Guard No.

(A) SALMON NET AREA REGISTRATION

Complete this section to register a vessel for salmon net fishing if the salmon net area was not designated at the time the vessel was licensed for the

current year. You may also change the designated area, as long as the vessel has NOT fished in the original area of registration. (If the vessel has

already fished in the original area, the Commissioner of the Dept. of Fish and Game must authorize the request to reregister in a different area and a

copy of the authorization must be attached to this form.) The current year's vessel license receipt MUST be returned with this form.

The vessel has been licensed but has not yet been registered for a salmon net registration area for 20____.

The vessel has been registered for a salmon net registration area in 20____ but has NOT participated in salmon fishing in that area.

The vessel has participated in salmon net fishing in 20____ in the original registration area, but I have been authorized by the

Commissioner of Fish and Game to re-register the vessel as provided in 5 AAC 39.120. (A copy of the authorization must be

attached.)

SALMON NET AREAS

A - Southeastern

Write in the letter representing the registration area: (listed at right)

E - Prince William Sound

__________ (Area) Current salmon net registration area, if applicable.

H - Cook Inlet

K - Kodiak

L - Chignik

__________ (Area) Area for which you wish to register the vessel.

M - Peninsula-Aleutians

CFEC permit number of salmon net permit(s) to be fished on the vessel: (example, S03T 99999)

T - Bristol Bay

W - Kuskokwim

Z - Norton Sound

1) SO __________________

2) SO _________________________

3) SO _______________________

(B) SALMON TROLL REGISTRATION

Complete this section to add salmon hand troll or power troll registration, or to change the registration, ONLY if the form is being submitted prior to

the start of the troll season. The current year's vessel license receipt MUST be returned with this form. Check hand OR power troll below and indicate

the date you wish the registration to be effective. (See 5 AAC 39.120(g) in the ADF&G regulation booklets.)

_____ Hand troll

_____ Power troll

Effective Troll Registration Date: ____________________

(Note: Vessel cannot sport fish for salmon after the troll registration effective date and cannot troll commercially before the effective date.

Complete this section to change the name and address of the vessel owner if it has changed since the license was issued for the current year. The

current year's vessel license receipt MUST be returned with this form, or a Request for Duplicate form (and appropriate fee) must also be submitted.

Has vessel ownership changed since it was licensed for the current year?

yes

n o

Date of ownership change: ___________________

______________________________________________________________

________________________________

___________________________

New Owner's Name (please print)

Soc. Sec. No.

Birth Date

______________________________________________________________

________________________________

_________

______________

Permanent Mailing Address

City

State

Zip Code

CERTIFICATION

I, _____________________________________________ , certify under penalty of perjury that all information contained on this document is true

and complete to the best of my knowledge and that I am the owner of the vessel or the owner's authorized agent.

_______________________________

___________________________________________________________________________________

Date

Signature of Owner or Owner's Agent

Mailing address for vessel area registration _______________________________________________________________________________

(if different than permanent address above) _______________________________________________________________________________

IN ORDER FOR THE CARBON COPY OF THIS FORM TO BE USED AS A TEMPORARY VESSEL LICENSE, IT MUST BE SIGNED BELOW BY AN EMPLOYEE OF THE ENTRY COMMISSION, DEPT. OF

FISH AND GAME OR DIVISION OF FISH AND WILDLIFE PROTECTION.

_________________________________________________

______________________________________

___________________

SIGNATURE OF CFEC, F&G OR FWP EMPLOYEE

NAME (PRINTED)

TITLE OR BADGE NO.

DATE

01-824WWW (REV.12/

99)