Data release form

November 4, 2009
OMB Control No.: 0648-0593
Expiration Date: 09/30/2012

Data Waiver Form

I, ________________________________, owner or authorized representative of the

fishing vessel, _____________________________, CG Documentation #______________,
submit this form under Section 402(b) (1) (F) of the Magnuson-Stevens Fishery Conservation
and Management Act, 16 U.S.C. 1881a(b) (1) (F), to authorize the release of observer
information collected for fishery conservation and management purposes aboard the
aforementioned vessel to:
___________________________________
____________________________________
_____________________________________
_____________________________________

Observer Data Waiver Period:

______________________________________

Comments:

_______________________________________
________________________________________

_____________________________________
Owner/Authorized Representative Signature
Please return to:
Amy Van Atten, Branch Chief
Fisheries Sampling Branch
NOAA Fisheries
166 Water Street
Woods Hole, MA 02543

________________________
Date Signed