Form NOAA 88-195 NOAA 88-195 Statement of Financial Interests

NOAA Form 88-195 (9/93)
U.S. Department of Commerce

OMB NO 0648 0192
Expiration Date 10/31/07

STATEMENT OF FINANCIAL INTERESTS

1) Name:

For Use By Voting Members of, and Nominees to, the Regional Fishery Management
Councils

2) Council:
3) Position:
____Member
____Nominee

4) Type of filing:
____Original filing [if nominee]
____Supplementary filing [if seated member]
____Annual filing [if seated member]
GENERAL PROVISIONS AND INSTRUCTIONS

Authority to Require this Information
Pursuant to Section 302(j) of the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) and the financial
disclosure regulations at 50 C.F.R. 600.235, you are required to disclose your financial interests if you are nominated by the Governor of a
State for appointment as a voting member of a Regional Fishery Management Council (Council), or if you are a voting member of a Council
appointed by the Secretary of Commerce under Section 302(b)(2) or (b)(5) of the Magnuson-Stevens Act.
Disclosure Requirements
On the attached form, list the financial interests held by yourself, your spouse, minor child, or partner, and any organization in which you are
serving as an officer, director, trustee, general partner, or employee. The nature of your participation in each financial interest, such as
ownership (percentage), directorship, employee, or contractor, must be identified. The information to be listed does not require a showing of
the amount of financial interest. You must include a description and the date acquired, for each such activity, of the fisheries participated in,
the product type produced, and, where applicable, the gear type utilized. For example, if you own a one-third interest in a fishing vessel, your
response might be: ABC Co., acquired 4/25/2000, 15 Main Street, Brunswick, Georgia 31521; commercial fishing vessel "Miss AMY," ID 123456; South Atlantic swordfish fishery, fresh swordfish, rod and reel; one-third ownership; John and Mary Doe (self and spouse). In the
event any of the required information, including holdings placed in trust, is not known to you but is known to another person, you should
request that other person to submit the information on your behalf and should report such request in the section titled "Information
Requested of Other Persons."
Requests for Assistance or Additional Information
Refer to the financial disclosure regulations at 50 C.F.R. 600.235 for additional information. If you have any questions regarding the
Statement of Financial Interests or related issues, please contact the Office of the Assistant General Counsel for Administration, U.S.
Department of Commerce, 14th and Constitution Avenue, N.W., Room 5882, Washington, D.C. 20230, or telephone (202) 482-5384.
Paperwork Reduction Act
Notwithstanding any other provision of law, no person is required to respond to nor shall a person be subject 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. The public reporting burden for this collection of information, on this NOAA Form 88-195, is
estimated to average 35 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 aspect of this collection of information, including suggestions for reducing this burden to the National Marine Fisheries Service, Office of
the Chief Information Officer (F/CIO), 1315 East-West Highway, SSMC #3, 3 Floor, Silver Spring, Maryland 20910.
rd

Public Access to Information
The Statements will be retained by the Council, made available for public review at reasonable hours at the Council Office, and at each public
hearing or public meeting.

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NOAA Form 88-195 (9/93)
U.S. Department of Commerce

OMB NO 0648 0192
Expiration Date 10/31/07

FINANCIAL INTERESTS DISCLOSURE

NOTE: If you have no applicable financial interests to disclose, write ANONE@ in the section below.
Company/Organization and Address
Date acquired:

Type of Company/Organization

Nature of Interest:

In Whose Name Held:
Fisheries/Species Participated In

Company/Organization and Address
Date acquired:

Gear Type Utilized

Type of Company/Organization

Product Type Produced

Nature of Interest:

In Whose Name Held:
Fisheries/Species Participated In

Company/Organization and Address
Date acquired:

Gear Type Utilized

Type of Company/Organization

Product Type Produced

Nature of Interest:
In Whose Name Held:

Fisheries/Species Participated In

Gear Type Utilized

Product Type Produced

NOTE: If none, write ANONE@ in the section above.
PLEASE WRITE OR PRINT YOUR NAME AND COUNCIL BELOW:
NAME:
COUNCIL:

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NOAA Form 88-195 (9/93)
U.S. Department of Commerce

OMB NO 0648 0192
Expiration Date 10/31/07

Information Requested of Other Persons. If any information is to be supplied by other persons, e.g., trustee, attorney, accountant, or
relative, please indicate the name and address of such persons, the date upon which you requested that the information be supplied and
the nature of the subject matter involved.
IF YOU HAVE NO APPLICABLE INFORMATION TO DISCLOSE, WRITE ANONE@ IN THE SECTION, BELOW.
Name and Address

Date of Request

Nature of Subject Matter

NOTE: If none, write ANONE@ in the section above.

Certification
I certify that the statements I have made are true complete and correct to the best of my knowledge and belief. I understand that if
during the period of my appointment, I undertake new employment, I must promptly file an amended statement, and I must also
report any new financial interests acquired during this period. I also certify that I am currently familiar with the statutes, regulations,
and policies governing my responsibilities and conduct as applied to the duties I am assigned.
NOTE:

PLEASE SIGN AND DATE THIS FORM, BELOW:

Signed: ______________________________________________________________________________
Dated: ______________________________________________________

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