U S DEPARTMENT OF HOMELAND SECURITY U S COAST GUARD SUBSTITUTE CG 1280 REV 06 04 OMB APPROVED 1625 0027 EXPIRATION DATE RENEWING ENDORSEMENTS ON A CERTIFICATE OF DOCUMENTATION Vessel ow

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U S DEPARTMENT OF HOMELAND SECURITY U S COAST GUARD SUBSTITUTE CG 1280 REV 06 04 OMB APPROVED 1625 0027 EXPIRATION DATE RENEWING ENDORSEMENTS ON A CERTIFICATE OF DOCUMENTATION Vessel ow Powered By Docstoc
					U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD (SUBSTITUTE) CG-1280 (REV. 06/04)

OMB APPROVED 1625 -0027 EXPIRATION DATE:

RENEWING ENDORSEMENTS ON A CERTIFICATE OF DOCUMENTATION Vessel owners are required to renew the endorsement(s) on Certificates of Documentation each year. Failure to renew the endorsement(s) may result in the vessel being removed from documentation. Operation of a vessel with expired endorsements may result in a civil penalty. If the vessel has been lost, sold, abandoned, destroyed, or placed under state numbering, the vessel owner must notify the National Vessel Documentation Center in writing. If the Certificate of Documentation is available, it must be surrendered. If any of the information shown on the Certificate of Documentation, other than the address of the owner, has changed, please contact the National Vessel Documentation Center for advice on how to proceed. The toll free telephone number is 1 800 799-8362. The endorsement(s) may be renewed by completing the substitute form CG-1280 which is published below. The Certification may be sent by facsimile mail to the National Vessel Documentation Center at (304) 271-2405. Although facsimile submissions are preferred, the Certification may be mailed to the National Vessel Documentation Center, 792 T J Jackson Drive, Falling Waters, WV 25419.

RENEWAL CERTIFICATION
I CERTIFY THAT THE RECITATIONS CONCERNING VESSEL NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS AND ENDORSEMENTS, CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME. . NAME(S) AND OFFICIAL NUMBER(S) OF VESSELS COVERED BY THIS CERTIFICATION: (May be listed on an attachment if necessary)

OWNER’S ADDRESS (IF CHANGED FROM ADDRESS SHOWN ON CERTIFICATE OF DOCUMENTATION)

Authorized Signature

Capacity of Person Signing

Date

AN AGENCY MAY NOT CONDUCT OR SPONSOR, AND A PERSON IS NOT REQUIRED TO RESPOND TO A COLLECTION OF INFORMATION UNLESS IT DISPLAYS A VALID OMB CONTROL NUMBER. THE COAST GUARD ESTIMATES THAT THE AVERAGE BURDEN FOR THIS FORM IS 5 MINUTES. YOU MAY SUBMIT ANY COMMENTS CONCERNING THE ACCURACY OF THIS BURDEN ESTIMATE OR MAKE SUGGESTIONS FOR REDUCING THE BURDEN TO: U.S. COAST GUARD, NATIONAL VESSEL DOCUMENTATION CENTER, 792 T J JACKSON DRIVE, FALLING WATERS, WEST VIRGINIA 25419, OR OFFICE OF MANAGEMENT AND BUDGET, PAPERWORK REDUCTION PROJECT (1625-0027), WASHINGTON, DC 20503.