Wreckfish share certificate and transfer form

OMB Number: 0648-0262
Expires: 12/31/2006
For the value of $__________, I (we) hereby sell, assign and transfer unto:
Name(s): ______________________________________________________________________
(As will appear on the certificate)
Address: _______________________________________________________________________
City/State/Zipcode: ______________________________________________________________
Employer ID No.: ________________________________________________________________
Telephone Number: ________________________________________________________________
__________ percentage shares represented by the within certificate and do hereby irrevocably
constitute and appoint the Transfer Agent to transfer the said shares on the books of the National
Marine Fisheries Service, Southeast Region.
_________________________________________________________________________________
Buyer's Signature
Position
________________________________________________________________________________
Additional Buyer, if held jointly
Position
Dated ______________________________________
_________________________________________________________________________________
Seller's Signature
Position
_________________________________________________________________________________
Additional Seller, if held jointly
Position
_______________________________________________________________
Signature of First Witness
In the presence of
_______________________________________________________________
Signature of Second Witness
Any or all share certificates previously issued in the name of any Buyer(s) named above must be
enclosed herewith for reissue pursuant to this transfer.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, 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 Jason Rueter, National Marine
Fisheries Service, F/SER24, 263 13th Avenue S., St. Petersburg, FL 33701. The National Marine Fisheries Service requires this information for
the conservation and management of marine fishery resources. The data reported will be used to develop, implement, and monitor fishery
management activities for a variety of other uses. Responses to this collection are required to obtain or retain a fisheries permit under the
Magnuson - Stevens Act. Information submitted will be submitted as confidential in accordance with NOAA Administrative Order 216-100,
Protection of Confidential Fishery Statistics. 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.