National Documentation Portal - Initial Vessel Documentation Form

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NOTE: FILING THIS APPLICATION DOES NOT ENTITLE A VESSEL TO DOCUMENTATION OR TO ANY CHANGES SOUGHT ON A CERTIFICATE OF DOCUMENTATION. OFFICIAL NUMBERS DESIGNATED ON THE BASIS OF THIS APPLICATION ARE NOT TRANSFERABLE. ONLY A CURRENT CERTIFICATE OF DOCUMENTATION IS VALID FOR VESSEL OPERATION. IN ORDER FOR A VESSEL TO BE DOCUMENTED UNDER U.S. COAST GUARD DOCUMENTATION, THE VESSEL MUST MEASURE AT LEAST FIVE NET TONS (WITH THE EXCEPTION OF CERTAIN OIL SPILL RESPONSE VESSELS) AND BE WHOLLY OWNED BY A CITIZEN OF THE UNITED STATES. VESSELS OF MORE THAN 25 FEET ARE LIKELY TO MEASURE FIVE NET TONS.

A.Vessel Name (Required)*

Insert name by which you wish the vessel to be known. If applying to change the vessel's name, insert the old vessel name in parenthesis. Only standard Alpha and Numeric Characters in the vessel name will appear on the Certificate of Documentation. Click icon for attachment if application covers multiple vessels.

Please select from the following:

I already own this vessel

I purchased this vessel from another owner

This vessel was just built

B. OFFICIAL # (IF AWARDED)

Insert the Official Number (O/N) awarded by the Coast Guard for all but Initial Issue cases.

C. HULL ID # (IF ANY)

Insert Hull Identification Number (HIN) as assigned in accordance with 33 CFR 81.

D. IMO # (IF ANY)

Insert International Maritime Organization Number (IMO), if any.

E. HAILING PORT INCLUDING STATE (TO BE MARKED ON VESSEL)

Insert name of place and state exactly as it is or will be marked on the vessel. The hailing port must be a place in the United States. Commonly used abbreviations such as ‘NY, NY’ are acceptable.

F. NAME OF MANAGING OWNER, E-MAIL ADDRESS, TELEPHONE NUMBER:

Name, e-mail address, and telephone number of the owner to whom the Coast Guard should send correspondence and their Social Security Number (SSN) or Tax Identification Number (TIN). Only an owner or part owner can be the managing owner. For vessels owned by a corporation, the corporation is the managing owner. For a trust arrangement, the trustee is the managing owner. For a Partnership or a LLC, the name of the Partnership or the LLC should be shown.

NAME OF MANAGING OWNER

E-MAIL ADDRESS OF MANAGING OWNER

TELEPHONE NUMBER OF MANAGING OWNER

SOCIAL SECURITY OR TAX ID NUMBER (46 USC 12104): (SECURE FORM)

IS THIS NUMBER YOUR SOCIAL SECURITY NUMBER OR YOUR TAX ID NUMBER?

SOCIAL SECURITY NUMBER

TAX ID NUMBER

G. PHYSICAL ADDRESS OF MANAGING OWNER (REQUIRED – 46 CFR 67.113)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter the mailing address. If physical (street) address differs from mailing address, enter BOTH.

MAILING ADDRESS OF MANAGING OWNER (IF DIFFERENT THAN PHYSICAL ADDRESS – E.G. , P.O. BOX)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

H. Are There Other Persons / Entities That Own an Interest in the Vessel?

If no, leave as is, otherwise select yes. Include all persons/entities (other than managing owner) who own an interest in the vessel below.

Name / Entity

Social Security Number (Individual)

If using Social Security Number leave Tax ID Number empty.

Tax ID Number (Business Entity)

If using Tax ID Number leave Social Security Number empty.

I. PURPOSE OF APPLICATION*

Check applicable blocks to show purpose of application. If vessel has never been documented, check Block #5 and provide ALL requested information known about the vessel's place and year of build, hull material, approximate length, and previous names and numbers. If this information is unknown, please indicate.

1. TRANSFER/EXCHANGE OF CERTIFICATE OF DOCUMENTATION

2. REPLACEMENT OF LOST, WRONGFULLY WITHHELD OR MUTILATED CERTIFICATE OF DOCUMENTATION

3. RE-INSTATEMENT OF CERTIFICATE OF DOCUMENTATION FOLLOWING FAILURE TO RENEW

4. RETURN TO DOCUMENTATION FOLLOWING DELETION.

5. APPLICATION FOR OFFICIAL NUMBER AND FIRST CERTIFICATE OF DOCUMENTATION.

VESSEL NAME WHEN LAST DOCUMENTED:

VESSEL

WAS BUILT AT

IS UNDER CONSTRUCTION AT

City, State, Country

Month, Year

IS UNDER CONSTRUCTION AT

AND IS SCHEDULED FOR COMPLETION IN

HULL MATERIAL:

WOOD

STEEL

FIBROUS REINFORCED PLASTIC

ALUMINUM

CONCRETE

OTHER

DESCRIBE

OVERALL VESSEL DIMENSIONS:

Overall Length (L):

Overall Length (L):

Overall Breadth (B):

Overall Breadth (B):

Overall Depth (D):

Overall Depth (D):

PREVIOUS NAMES, NUMBERS, OR FOREIGN REGISTRATIONS OF VESSEL

J. ENDORSEMENTS FOR WHICH APPLICATION IS MADE

Check the appropriate block(s) to indicate all endorsement(s) sought on this application.

RECREATIONAL

FISHERY

COASTWISE

REGISTRY

COASTWISE – BOWATERS ONLY (CERTIFICATE ON FILE)

COASTWISE – OIL SPILL RESPONSE ONLY (LETTER OF QUALIFICATION ON FILE)

COASTWISE UNDER CHARTER TO AN ENTITY QUALIFIED TO ENGAGE IN COASTWISE TRADE (COPY OF CHARTER ON FILE)

K. PRIMARY SERVICE & HORSEPOWER: SELECT ONLY ONE SERVICE FOR WHICH THE VESSEL WILL BE PRIMARILY USED AND INSERT HORSEPOWER

COMMERCIAL FISHING BOAT

FISH PROCESSING VESSEL

FREIGHT SHIP

INDUSTRIAL VESSEL

MOBILE OFFSHORE DRILLING UNIT

OIL RECOVERY

OFFSHORE SUPPLY VESSEL

PASSENGER (6 OR FEWER)

PASSENGER (MORE THAN 6)

PASSENGER BARGE (6 OR FEWER)

PASSENGER BARGE (MORE THAN 6)

PUBLIC FREIGHT

PUBLIC TANKSHIP/BARGE

PUBLIC VESSEL, UNC

RECREATIONAL

RESEARCH VESSEL

SCHOOL SHIP

TANK BARGE

TANK SHIP

TOWING VESSEL

UNCLASSIFIED VESSEL

HORSEPOWER

L. CITIZENSHIP OF OWNER (CHECK THE BOX(ES) TO SHOW THE TYPE(S) OF ENTITY(IES) THAT OWNS THE VESSEL)
Vessel must be owned by a U.S. citizen eligible for the endorsement(s) sought. Select the section that describes the type of entity that owns the vessel. Citizenship for all owners must be provided.

INDIVIDUAL: Includes native born and naturalized U.S. citizens. GOVERNMENT ENTITY: Includes Federal, State, Territory, Possession or Subdivision. CORPORATION: Complete all items that apply. LIMITED LIABILITY COMPANY (LLC): Complete Equity Section and choose type. For member managed LLC, a list of members is required. Click icon for attachment if application covers multiple members. PARTNERSHIP: Complete Equity Section and choose type. A list of all general partners is required. Click icon for attachment if application covers multiple general partners. CORPORATIONS QUALIFIED UNDER 46 CFR 68.01 OR OWNED BY A NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE: Attach a copy of the Certificate of Compliance or Letter of Qualification issued by the Director, NVDC. JOINT VENTURE/ASSOCIATION: A list of all joint venturers/members is required. The percentage held by each need not be shown. Click icon for attachment if application covers multiple joint venturers/members. TRUST ARRANGEMENT: All trustees must be U.S. citizens. If applicable, each beneficiary with an enforceable interest must be a citizen. A list of all trustees (except managing owner) and beneficiaries with an enforceable interest is required. Click icon for attachment if application covers multiple trustees/beneficiaries with an enforceable interest.

INDIVIDUAL: Includes native born and naturalized U.S. citizens.

GOVERNMENT ENTITY: Includes Federal, State, Territory, Possession or Subdivision.

CORPORATION: Complete all items that apply.

LIMITED LIABILITY COMPANY (LLC): Complete Equity Section and choose type. For member managed LLC, a list of members is required. Click icon for attachment if application covers multiple members.

PARTNERSHIP: Complete Equity Section and choose type. A list of all general partners is required. Click icon for attachment if application covers multiple general partners.

CORPORATIONS QUALIFIED UNDER 46 CFR 68.01 OR OWNED BY A NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE: Attach a copy of the Certificate of Compliance or Letter of Qualification issued by the Director, NVDC.

JOINT VENTURE/ASSOCIATION: A list of all joint venturers/members is required. The percentage held by each need not be shown. Click icon for attachment if application covers multiple joint venturers/members.

TRUST ARRANGEMENT: All trustees must be U.S. citizens. If applicable, each beneficiary with an enforceable interest must be a citizen. A list of all trustees (except managing owner) and beneficiaries with an enforceable interest is required. Click icon for attachment if application covers multiple trustees/beneficiaries with an enforceable interest.

ONE OR MORE INDIVIDUALS, I (WE) CERTIFY THAT ALL OWNERS OF THIS VESSEL ARE CITIZENS OF THE UNITED STATES

GOVERNMENT ENTITY (FEDERAL, STATE, TERRITORY, POSSESSION OR SUBDIVISION)

CORPORATION (SEE SECTION M, ITEM 4 WHEN APPLYING FOR A FISHERY OR COASTWISE ENDORSEMENT).

LIMITED LIABILITY COMPANY (LLC) (COMPLETE EQUITY SECTION AND CHOOSE TYPE)

PARTNERSHIP (COMPLETE EQUITY SECTION AND CHOOSE TYPE)

CORPORATION QUALIFIED AND APPLYING UNDER 46 CFR 68.01 (BOWATERS)

VESSEL OWNED OR OPERATED BY NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE

JOINT VENTURE OR ASSOCIATION

TRUST ARRANGEMENT (COMPLETE EQUITY/STOCK SECTION)

1. STATE OF INCORPORATION

2 CITIZENSHIP OF CHIEF EXECUTIVE OFFICER BY WHATEVER TITLE

3. CITIZENSHIP OF CHAIRMAN OF THE BOARD

4. NUMBER OF DIRECTORS NECESSARY TO CONSTITUTE A QUORUM

5. NUMBER OF ALIEN DIRECTORS

6. PERCENTAGE OF STOCK OWNED BY U.S. CITIZENS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT, WITH THE ENDORSEMENT(S) SOUGHT ON THIS APPLICATION IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)

LESS THAN 50%

50% OR MORE: (I)

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

STATE EXACT PERCENTAGE

CORPORATION QUALIFIED AND APPLYING UNDER 46 CFR 68.01 (BOWATERS)

I (WE) CERTIFY THAT THE CORPORATE STRUCTURE HAS NOT CHANGED SINCE ISSUANCE OF THE CERTIFICATE OF COMPLIANCE.

VESSEL OWNED OR OPERATED BY NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE

I (WE) CERTIFY THAT THE INFORMATION ON FILE WITH REGARD TO COOPERATIVE AND ISSUANCE OF THE LETTER OF QUALIFICATION REMAINS UNCHANGED.

JOINT VENTURE OR ASSOCIATION

I (WE) CERTIFY THAT ALL MEMBERS OF THIS (JOINT VENTURE) (ASSOCIATION) ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT(S) SOUGHT.

LIMITED LIABILITY COMPANY (LLC): (COMPLETE EQUITY SECTION AND CHOOSE TYPE) (SEE SECTION M, ITEM 5 WHEN APPLYING FOR A FISHERY OR COASTWISE ENDORSEMENT).

EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C).

LESS THAN 50%

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

50% OR MORE: (I)

List of All Joint Ventures/Members (First & Last Name(s)):

STATE EXACT PERCENTAGE

1. MEMBER MANAGED LIMITED LIABILITY COMPANY I (WE) CERTIFY THAT ALL MEMBERS OF THIS LLC ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

LIST OF ALL MEMBERS (FIRST & LAST NAME(S)):

2. LIMITED LIABILITY COMPANY NOT MANAGED BY MEMBERS AND NOT SIMILAR TO GENERAL PARTNERSHIP: PLEASE NOTE (A) & (B) MUST BE CHECKED FOR FISHERY AND COASTWISE ENDORSEMENTS; NOT REQUIRED FOR COASTWISE OIL SPILL OR COASTWISE UNDER CHARTER ENDORSEMENTS.

A. I (WE) CERTIFY THAT ANY PERSON ELECTED TO MANAGE THE LLC OR WHO IS AUTHORIZED TO BIND THE LLC, AND ANY PERSON WHO HOLDS A POSITION EQUIVALENT TO THE CHIEF EXECUTIVE OFFICER, BY WHATEVER TITLE, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS IN A CORPORATION, AND ANY PERSONS AUTHORIZED TO ACT IN THEIR ABSENCE ARE CITIZENS OF THE UNITED STATES

B. NON-CITIZENS DO NOT HAVE AUTHORITY WITHIN A MANAGEMENT GROUP, WHETHER THROUGH VETO POWER, COMBINED VOTING, OR OTHERWISE, TO EXERCISE CONTROL OVER THE LLC

STATE WHERE ORGANIZED

PARTNERSHIP (COMPLETE EQUITY SECTION AND CHOOSE TYPE) (SEE SECTION M, ITEM 5 WHEN APPLYING FOR FISHERY OR COASTWISE ENDORSEMENT) EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)

LESS THAN 50%

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

50% OR MORE: (I)

STATE EXACT PERCENTAGE

1. GENERAL PARTNERSHIP
I (WE) CERTIFY THAT ALL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

2. LIMITED PARTNERSHIP
I (WE) CERTIFY THAT ALL GENERAL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

LIST ALL GENERAL PARTNERS (REQUIRED)

TRUST ARRANGEMENT

I (WE) CERTIFY THAT ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST IN THIS TRUST ARRANGEMENT ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT(S) SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)

LESS THAN 50%

50% OR MORE: (I)

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

STATE EXACT PERCENTAGE

VESSEL OWNED IN A TRUST ARRANGEMENT PURSUANT TO 46 USC 12111(c) (CROSS BORDER FINANCING)

LIST OF ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST (REQUIRED)

M. I (WE) CERTIFY THAT: (MARK ALL THAT ARE APPLICABLE. ITEM 5. NOT REQUIRED FOR COASTWISE BOWATER ONLY, OIL SPILL, OR UNDER CHARTER ENDORSEMENTS.)

Complete as appropriate. The law provides severe penalties for false statements against both the person (including agents) making the statement and against the vessel for which it is made.

1. I AM (WE ARE) A CITIZEN(S) OF THE UNITED STATES AND LEGALLY AUTHORIZED TO EXECUTE THIS APPLICATION IN THE CAPACITY SHOWN;

2. IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART I) THE VESSEL(S) TO WHICH THIS APPLICATION APPLIES;

(b) WILL AT ALL TIMES REMAIN UNDER THE COMMAND OF A U.S. CITIZEN, UNLESS DOCUMENTED SOLELY WITH A RECREATIONAL ENDORSEMENT; WILL NOT BE OPERATED IN A TRADE NOT AUTHORIZED BY THE ENDORSEMENT(S) ON THE CERTIFICATE(S) OF DOCUMENTATION. THE NAME(S) OF THE VESSEL(S) WILL NOT BE CHANGED WITHOUT APPROVAL FROM THE NATIONAL VESSEL DOCUMENTATION CENTER; AND I (WE) WILL PROMPTLY NOTIFY THE NATIONAL VESSEL DOCUMENTATION CENTER UPON A CHANGE IN ANY OF THE INFORMATION OR REPRESENTATIONS IN THIS APPLICATION.

(a) HAS (HAVE) BEEN MARKED

WILL BE MARKED;

3. HAS (HAVE) NOT OR

3a. HAS (HAVE) BEEN REBUILT OR SUBSTANTIALLY ALTERED SINCE LAST DOCUMENTATION;

4. THE VESSEL IS (NOT TITLED UNDER A STATE OR TITLED UNDER THE LAWS OF [INPUT])

THE VESSEL IS

NOT TITLED UNDER A STATE (OR)

TITLED UNDER THE LAWS OF (INPUT BELOW)

TITLED UNDER THE LAWS OF:

THE FOLLOWING ITEM (5.) IS REQUIRED FOR COASTWISE AND/OR FISHERY ENDORSEMENTS; HOWEVER, IT IS NOT REQUIRED FOR COASTWISE BOWATER ONLY, OIL SPILL, OR UNDER CHARTER ENDORSEMENTS.

5. U.S. CONTROL CERTIFICATION: THERE IS NO CONTRACT OR UNDERSTANDING THAT PROVIDES MORE THAN 25% OF THE VOTING POWER IN THE PARTNERSHIP, LIMITED LIABILITY COMPANY, CORPORATION, OR OTHER OWNING ENTITY EITHER DIRECTLY OR INDIRECTLY ON BEHALF OF ANY PERSON NOT A CITIZEN OF THE UNITED STATES. BY NO MEANS WHATSOEVER IS CONTROL IN EXCESS OF 25% CONFERRED UPON OR PERMITTED TO BE EXERCISED BY A PERSON WHO IS NOT A CITIZEN OF THE UNITED STATES.

POTENTIAL PENALTIES FOR FALSE STATEMENTS OR REPRESENTATIONS BY OWNER OR REPRESENTATIVE: CIVIL, MONETARY, VESSEL FORFEITURE (46 USC 12151), FINE AND/OR IMPRISONMENT (18 USC 1001)

AUTHORIZED SIGNATURE*

SIGNATURE (TYPE FULL NAME)

Signature*

DATE

MM slash DD slash YYYY

CAPACITY (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

APPLICATION FEES ARE NOT REFUNDABLE (46 CFR 67.500 (e)).

PRIVACY ACT STATEMENT IN ACCORDANCE WITH 5 U.S.C. 553a, THE FOLLOWING INFORMATION IS PROVIDED TO YOU WHEN SUPPLYING PERSONAL INFORMATION TO THE U.S. COAST GUARD. 1. AUTHORITY. SOLICITATION OF THIS INFORMATION IS AUTHORIZED BY 46 U.S.C., CHAPTERS 121 AND 125; 46 U.S.C. APP. 802 AND 883. 2. THE PRINCIPAL PURPOSES FOR WHICH THIS INFORMATION IS TO BE USED ARE: (1) TO DETERMINE CITIZENSHIP OF THE OWNER OF THE VESSEL FOR WHICH APPLICATION FOR DOCUMENTATION IS MADE; AND (2) TO DETERMINE ELIGIBILITY OF THE VESSEL TO BE DOCUMENTED WITH THE TRADE ENDORSEMENT SOUGHT. 3. THE ROUTINE USES WHICH MAY BE MADE OF THIS INFORMATION INCLUDE RELEASE TO LAW ENFORCEMENT OFFICIALS, TO THE GENERAL PUBLIC UNDER FREEDOM OF INFORMATION ACT, AND TO PUBLISH INFORMATION ABOUT U.S. DOCUMENTED VESSELS. 4. DISCLOSURE OF THE INFORMATION REQUESTED ON THIS FORM IS VOLUNTARY, HOWEVER, FAILURE TO PROVIDE THE INFORMATION REQUESTED WILL RESULT IN DENIAL OF THE APPLICATION FOR DOCUMENTATION, WHICH MAY PREVENT THE OWNER FROM OPERATING THE VESSEL(S) IN A SPECIFIED TRADE.

Nicks Product

Price:

Initial Documentation

Price:

Please select any additional services you wish to add to have processed

Priority Request/Rush Processing

Abstract of Title

Certified Copy of COD

Preferred Mortgage

Satisfaction of Mortgage

Based on your submission, the following service(s) are also required:

Coastwise Endorsement

Price:

Fishery Endorsement

Price:

PRIORITY REQUEST REQUEST / RUSH PROCESSING

Reason for Priority Request

I (we) understand that making a false statement when applying for vessel documentation may subject the vessel to seizure by and forfeiture to the United States Government (46 USC §12151, formerly 46 USC §12122).

PREFERRED MORTGAGE

INSTRUMENT TYPE (CHECK ALL THAT APPLY)

PREFERRED MORTGAGE

CHATTEL MORTGAGE

AMENDMENT

ASSUMPTION

SUPPLEMENT

SUBORDINATION

ASSIGNMENT

OTHER (DESCRIBE)

Describe

NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)

GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES.

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)

NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)

GRANTEE. FOR PURPOSES OF THIS FORM, GRANTEES INCLUDE MORTGAGEES, ASSIGNEES, PERSON FROM WHOM MORTGAGES ARE ASSUMED, AND PERSON TO WHOM SUBORDINATION OF MORTGAGES ARE GRANTED. LIST ALL GRANTEES AND ADDRESSES.

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)

Amount

SATISFACTION OF MORTGAGE

INSTRUMENT TYPE (CHECK ALL THAT APPLY)

PREFERRED MORTGAGE

CHATTEL MORTGAGE

AMENDMENT

ASSUMPTION

SUPPLEMENT

SUBORDINATION

ASSIGNMENT

OTHER (DESCRIBE)

Describe

NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)

GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES.

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)

NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)

PERCENTAGE OF VESSEL MORTGAGED OR MORTGAGE ASSIGNED (100% UNLESS OTHERWISE STATED)

Amount

IF THE FOLLOWING INFORMATION IS UNKNOWN YOU MUST ORDER AN ABSTRACT OF TITLE UNDER ADDITIONAL SERVICES TOWARDS THE TOP OF THE PAGE.

RECORDED BOOK:

Page

FILE/RECORDED DATE:

MM slash DD slash YYYY

TIME:

OTHER IDENTIFYING DATA:

Vessel Type?*

Recreational

Commercial

NOTE: Your yearly certificate will be valid for one year only. You will receive one (1) Year long certificate each year, depending on how many additional years you have ordered. For each individual year of renewal, a new renewal will be AUTOMATICALLY forwarded to your designated address at the time of renewal(s). This may require that the vessel owner update their current address to facilitate the renewal process.

USCG RENEWAL DOCUMENTATION ADVANCED PAYMENT OPTION

1 year renewal

2 year renewal

3 year renewal

4 year renewal

Total

Authorization*

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected USCG documents. I understand that my application will be processed in the order in which it is received by Vessel Documentation Online, a private documentation firm. I understand that application and processing fees are non-refundable as per Vessel Documentation Online's no refund policy and as per 46 CFR 67.500(e). I understand that submitting another application for vessel documentation will supersede the current/pending application for that vessel.

Credit Card*

Card Details

Cardholder Name

Having Trouble? Check this box to move forward without your Credit Card

*My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment

BILLING ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Phone*

(###) ###-####

Agree to Terms and Conditions*

I agree to the terms and conditions below:

By clicking submit you agree to these Terms and Conditions and the above authorization of payment.