Builders Cert and First Transfer of Title 1261

DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-1261 (REV. 9-05)

BUILDER’S CERTIFICATION AND
FIRST TRANSFER OF TITLE

OMB APPROVED
1625-0027

I. VESSEL DATA
A. VESSEL NAME

B. OFFICIAL NUMBER (IF ANY)

C. HULL IDENTIFICATION NUMBER OR HULL NUMBER

D. EQUIPPED WITH ENGINE?
YES
NO

OUTBOARD?
YES

NO

E. HULL MATERIAL
WOOD

FRP (FIBERGLASS)

ALUMINUM

CONCRETE

STEEL

OTHER _____________________________________
II. UNITED STATES BUILD STATEMENT
ALL MAJOR COMPONENTS USED IN THE PHASE OF CONSTRUCTION COVERED BY THIS CERTIFICATE
WERE FABRICATED IN THE UNITED STATES.
ALL CONSTRUCTION AND ALL ASSEMBLY FOR THIS PHASE OF CONSTRUCTION WERE DONE IN THE
UNITED STATES.
III. DIMENSIONS
(COMPLETE APPROPRIATE DIAGRAM)

SHIP-SHAPE HULL

BARGE-SHAPED HULLS

L=

FT

IN

L=

FT

IN

B=

FT

IN

B=

FT

IN

D=

FT

IN

D=

FT

IN

L=

FT

IN

B=

FT

IN

D=

FT

IN

D1 =

FT

IN

SAILBOAT

D1 ONLY IF ACTUAL HULL DEPTH (D) CANNOT BE
DETERMINED.

(TEST) PREVIOUS EDITION OBSOLETE

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CATAMARAN

TRIMARAN

DECKHOUSES

L=

FT

IN

B=

FT

IN

B1 =

FT

IN

D=

FT

IN

L=

FT

IN

L1 =

FT

IN

L2 =

FT

IN

B=

FT

IN

B1 =

FT

IN

B2 =

FT

IN

D=

FT

IN

D1 =

FT

IN

L=

FT

IN

B=

FT

IN

D=

FT

IN

HOUSEBOATS ONLY:
(AVERAGE DECKHOUSE DIMENSIONS MUST BE
FURNISHED IN ADDITION TO HULL DIMENSIONS)
(TEST) PREVIOUS EDITION OBSOLETE

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IV. NAME(S) AND ADDRESS(ES) OF PARTY(IES) FOR WHOM BUILT (ADDITIONAL PARTIES)

NAME
ADDRESS

CITY
STATE
ZIP + 4
IF BUILT FOR MORE THAN ONE PERSON, THE PERSONS NAMED ABOVE ARE TENANTS IN COMMON, EACH OWNING AN EQUAL UNDIVIDED
INTEREST, UNLESS OTHERWISE INDICATED HEREIN: CHECK ONLY ONE OF THE FOLLOWING BLOCKS TO SHOW ANOTHER FORM OF
OWNERSHIP.
JOINT TENANCY WITH RIGHT OF SURVIVORSHIP
OTHER (DESCRIBE)

.
WHOLE NUMBER & PERCENT

TENANCY BY THE ENTIRETY

OR

COMMUNITY PROPERTY

WHOLE NUMBER & FRACTION

V. CERTIFICATION
I CERTIFY THAT: (CHECK ONE)
THE ENTIRE CONSTRUCTION OF THE VESSEL WAS COMPLETED IN
CITY

STATE

COUNTRY

YEAR

THE HULL ONLY PHASE OF THE VESSEL WAS COMPLETED IN
CITY

STATE

COUNTRY

YEAR

THE COMPLETION PHASE ONLY OF THE VESSEL WAS COMPLETED IN
CITY

STATE

COUNTRY

YEAR

I, _____________________________________________DO HEREBY CERTIFY THAT THE FACTS RECITED HEREIN
ARE TRUE AND THAT I HAVE PERSONAL KNOWLEDGE OF THESE FACTS BECAUSE I:
PERSONALLY PERFORMED THE CONSTRUCTION
OR
SUPERVISED THE CONSTRUCTION AT AND ON BEHALF OF:
____________________________________________________________________________________________
(NAME OF COMPANY)

ACTING IN MY CAPACITY AS ________________________________________________________________ OF
(TITLE)
___________________________________________________________________________________________________________________
(NAME OF COMPANY)
NOTE: THIS CERTIFICATE MUST NOT BE
COMPLETED BY AN IMPORTER, OR AN
OWNER’S OR IMPORTER’S AGENT.
(TEST) PREVIOUS EDITION OBSOLETE

______________________________________________
SIGNATURE

_____________________________
DATE
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VI. FIRST SALE OR TRANSFER OF VESSEL
100% OF THE VESSEL IDENTIFIED HEREIN IS SOLD (TRANSFERRED) BY THE PARTY(IES) NAMED IN SECTION
IV TO THE FOLLOWING PERSON(S) (NAMES AND ADDRESSES)
(ADDITIONAL BUYERS)
NAME
ADDRESS

-CITY

STATE

ZIP + 4

IF SOLD (TRANSFERRED) TO MORE THAN ONE PERSON, THE PURCHASER(S) (TRANSFERREE(S)) ARE
TENANTS IN COMMON, EACH OWNING AN EQUAL UNDIVIDED INTEREST, UNLESS OTHERWISE INDICATED
HEREIN: CHECK ONLY ONE OF THE FOLLOWING BLOCKS TO SHOW ANOTHER FORM OF OWNERSHIP.
JOINT TENANCY WITH RIGHT OF SURVIVORSHIP

TENANCY BY THE ENTIRETY

COMMUNITY PROPERTY

OTHER (DESCRIBE)

OR

.

WHOLE NUMBER & FRACTION

WHOLE NUMBER & PERCENT

VII. SIGNATURES OF SELLER(S) (TRANSFEROR(S)) OR PERSONS SIGNING ON BEHALF OF SELLER(S)
(TRANSFEROR(S)):
DATE SIGNED:
VIII. NAME(S) OR PERSON(S) SIGNING ABOVE, AND LEGAL CAPACITY IN WHICH SIGNED (E.G. OWNER, AGENT,
TRUSTEE, EXECUTOR)
IX. ACKNOWLEDGMENT (TO BE COMPLETED BY NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED BY A
LAW OF A STATE OR THE UNITED STATES TO TAKE OATHS.)
ON

THE PERSON(S)
MONTH

DAY

YEAR

NAMED IN SECTION VIII ABOVE ACKNOWLEDGED EXECUTION
OF THE FOREGOING INSTRUMENT IN THEIR STATED
CAPACITY(IES) FOR THE PURPOSES THEREIN CONTAINED.

STATE:________________________________
COUNTY:_________________________________
_________________________________
NOTARY PUBLIC
MY COMMISSION EXPIRES:

POTENTIAL PENALTIES FOR FALSE STATEMENTS OR REPRESENTATION BY OWNER OR REPRESENTATIVE: VESSEL FORFEITURE (46
USC 12122) AND FINE AND/OR IMPRISONMENT (18 USC 1001)
PRIVACY ACT STATEMENT
IN ACCORDANCE WITH 5 USC 552(a), 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 USC, CHAPTER 313 AND 46 CFR, PART 67.
2. THE PRINCIPAL PURPOSES FOR WHICH THIS INSTRUMENT IS TO BE USED ARE:
(A) TO PROVIDE A RECORD, AVAILABLE FOR PUBLIC INSPECTION AND COPYING, OF THE SALE OR OTHER CHANGE IN
OWNERSHIP OF A VESSEL WHICH IS DOCUMENTED, WILL BE DOCUMENTED, OR HAS BEEN DOCUMENTED PURSUANT
TO 46 USC, CHAPTER 121.
(B) PLACEMENT OF THIS INSTRUMENT IN A BOOK FOR EXAMINATION BY GOVERNMENTAL AUTHORITIES AND MEMBERS
OF THE GENERAL PUBLIC.
3. THE ROUTINE USE WHICH MAY BE MADE OF THIS INFORMATION INCLUDES DEVELOPMENT OF STATISTICAL DATA CONCERNING
DOCUMENTED VESSELS.
4. DISCLOSURE OF THE INFORMATION REQUESTED ON THIS FORM IS VOLUNTARY; HOWEVER, FAILURE
TO PROVIDE THE INFORMATION COULD PRECLUDE FILING OF A BILL OF SALE AND DOCUMENTATION
OF THE VESSEL NAMED HEREIN PURSUANT TO 46 USC, CHAPTER 121. MOREOVER, BILLS OF SALE
WHICH ARE NOT FILED ARE NOT DEEMED TO BE VALID AGAINST ANY PERSON EXCEPT THE GRANTOR
OR A PERSON HAVING ACTUAL KNOWLEDGE OF THE SALE. (46 USC 31321(a)).
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 30 MINUTES. YOU MAY SUBMIT ANY COMMENTS
CONCERNING THE ACCURACY OF THIS BURDEN ESTIMATE OR ANY SUGGESTIONS FOR REDUCING THE BURDEN TO: COMMANDANT
(NVDC), U.S. COAST GUARD, WASHINGTON, DC 20593-0001 OR OFFICE OF MANAGEMENT AND BUDGET, PAPERWORK REDUCTION
PROJECT (1625-0027), WASHINGTON, DC 20593.
(TEST) PREVIOUS EDITION OBSOLETE

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