Wreckfish quota share transfer form

Southeast Region IFQ Programs

revised Wreckfish Shareholder Certificate template

Wreckfish quota share transfer

OMB: 0648-0551

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U. S. Department of Commerce, NOAA

National Marine Fisheries Service

263 13th Avenue South

St. Petersburg, FL 33701



Certificate No. [certificate number]



This is to Certify that [shareholder name]

is the owner of [shares] percentage shares of the

Wreckfish Fishery transferable only on the books of the National Marine Fisheries Service, Southeast Region, by the holder hereof upon Surrender of this certificate properly endorsed.


Witness, the signatures of its duly authorized officers





_____________________________________________________________

Transfer Agent




_____________________________________________________________

Regional Administrator




____________________________________________

Date




Public reporting burden for this collection of information is estimated to average 20 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 PRA Officer, National Marine Fisheries Service, 263 13th Ave South, 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.


OMB Number: 0648-0551

Expires: 11/30/2014


For the value of $____________, I (we) hereby sell, assign and transfer unto:


Name(s): _____________________________________________________________________________________

First, Middle, and Last Name(s) or Name of Business* as will appear on the certificate


Mailing Address: ______________________________________________________________________________


City/State/Zipcode: ____________________________________________________________________________


_____________________________ _______________________________ ____________________________

Tax ID # (Federal Tax ID or SSN) Date of Birth or Date Business Filed (Area code) Phone Number

(MM/DD/YYYY)


*If the shareholder’s certificate is owned by a business, then complete this section for each officer and shareholder associated with the business. Please attach additional sheets as necessary to list all officers, directors, shareholders, and registered agents of the business.


Position held – check ALL that apply

President ____ Vice President ____ Secretary____ Treasurer____ Director/Manager____ Shareholder____ Other_____


Percent (%) of corporation held ______________


Name: _______________________________________________________________________________________

First, Middle, and Last Name


Mailing Address: ______________________________________________________________________________


City/State/Zipcode: ____________________________________________________________________________


_____________________________ _______________________________ ____________________________

Tax ID # (Federal Tax ID or SSN) Date of Birth or Date Business Filed (Area code) Phone Number

(MM/DD/YYYY)


________ 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 Date


____________________________________________________________________________________________

Additional Buyer, if held jointly Position Date



____________________________________________________________________________________________

Seller’s Signature Position Date


____________________________________________________________________________________________

Additional Seller, if held jointly Position Date


NOTARY PUBLIC: The above instrument was acknowledged before me this ______ day of __________________ ________.

Day Month Year


by ________________________________________________________ who is personally known to me or who has produced

Name of certificate seller


_____________________________________________________________________________________ as identification.

Type of identification



___________________________________________________________________, Notary Public Commission Number: _______________________

Signature of Notary Public



__________________________________________________________________

Name of Notary typed, printed or stamped


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.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCertificate No
File Modified0000-00-00
File Created2021-01-26

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