CG-5542 Optional Application for Filing

OMB APPROVED 1625-0027
EXPIRATION DATE:
THIS SECTION FOR COAST GUARD USE ONLY

OPTIONAL APPLICATION FOR FILING

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-5542 (REV. 06/04)
1. NAME OF VESSEL

(SEE INSTRUCTIONS AND PRIVACY ACT
ON REVERSE)
(ATTACH SCHEDULE IF MORE THAN ONE VESSEL)

2. OFFICIAL NUMBER
OR OTHER UNIQUE IDENTIFIER
RECORDED

3. INSTRUMENT TYPE: (CHECK ALL THAT APPLY)
PORT
PREFERRED MORTGAGE

ASSUMPTION

AMENDMENT

CHATTEL MORTGAGE

SUPPLEMENT

SUBORDINATION

BOOK
PAGE
OTHER (DESCRIBE)

ASSIGNMENT
BY

4. NAME(S) AND ADDRESS(ES) OF GRANTOR(S)

(MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S) --SEE INSTRUCTIONS)

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT

%.

(100% UNLESS OTHERWISE STATED)

_______________________________

5. NAME(S) AND ADDRESS(ES) OF GRANTEE(S)

(MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S) -- SEE INSTRUCTIONS)

PERCENTAGE OF VESSEL MORTGAGED OR MORTGAGE ASSIGNED

%.

(100% UNLESS OTHERWISE STATED)

_______________________________________

6. AMOUNT

7. IDENTIFICATION ON INSTRUMENT ASSUMED, ASSIGNED, AMENDED, SUPPLEMENTED,
SUBORDINATED, OR OTHERWISE MODIFIED:

RECORDED BOOK:

PAGE:

FILE/RECORDED DATE:

TIME:

OTHER IDENTIFYING DATA:

8. CERTIFICATION AND ATTESTATION:
I (WE) HEREBY CERTIFY THAT THE FACTS RECITED HEREIN ARE TRUE AND CORRECT. I (WE) UNDERSTAND THAT THE U.S. COAST
GUARD WILL RELY ON THOSE RECITATIONS IN INDEXING THE ATTACHED INSTRUMENT.
SIGNATURE(S): (SEE INSTRUCTIONS)
FOR THE GRANTOR(S)

FOR THE GRANTEE(S)

_________________________________________________________

_____________________________________________________________________________________________________________

_________________________________________________________

______________________________________________________________________________________________________________

STATE:
COUNTY:
SUBSCRIBED AND SWORN BEFORE ME ON:
___________________________________________________________________

_________________________________________________________________________________________________

NOTARY PUBLIC
MY COMMISSION EXPIRES:
_______________________________________________________________

(DATE)

WARNING: FALSE STATEMENT MAY RESULT IN FINE OR IMPRISONMENT PURSUANT TO TITLE 18 USC.

PREVIOUS EDITION OBSOLETE

SN 7530-01-GF3-2550

REVERSE OF CG-5542 (REV. 06/04)

INSTRUCTIONS
1. SELF-EXPLANATORY. A SCHEDULE MAY BE ATTACHED IF MORE THAN ONE VESSEL IS AFFECTED BY THE
INSTRUMENT ATTACHED.
2. LIST COAST GUARD ASSIGNED OFFICIAL NUMBER, MANUFACTURER’S HULL IDENTIFICATION NUMBER (HIN)
ASSIGNED IN ACCORDANCE WITH RULES IN 33 CFR, OR OTHER UNIQUE IDENTIFIER, (STATE MOTORBOAT NUMBERS
ARE NOT CONSIDERED UNIQUE IDENTIFIERS.)
3. SELF-EXPLANATORY.
4. GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING
MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES. A
SEPARATE SCHEDULE MAY BE ATTACHED IF MORE ROOM IS NEEDED.
5. 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. A SEPARATE SCHEDULE MAY BE ATTACHED IF MORE ROOM IS NEEDED.
6. SELF-EXPLANATORY.
7. NOT USED FOR NEW CHATTEL OR PREFERRED MORTGAGES. MUST BE COMPLETED FOR ASSUMPTIONS,
ASSIGNMENTS, AMENDMENTS, OR OTHER INSTRUMENTS MODIFYING CHATTEL OR PREFERRED MORTGAGE FILED
PREVIOUSLY OR CONCURRENTLY.
8. REQUIRED SIGNATURES AND NOTARIZATION:
- CHATTEL OR PREFERRED MORTGAGES, AMENDMENTS, OR SUPPLEMENTS: GRANTOR AND GRANTEE OR
PERSONS ACTING ON BEHALF OF THOSE ENTITIES.
- ASSUMPTION OF MORTGAGE: ASSUMING PARTY AS GRANTOR, ORIGINAL MORTGAGOR AND MORTGAGEE AS
GRANTEES, OR PERSONS ACTING ON BEHALF OF THOSE ENTITIES.
- SUBORDINATION AGREEMENT OR ASSIGNMENT: GRANTOR OF SUBORDINATION AGREEMENT OR ASSIGNMENT, OR
PERSON ACTING ON BEHALF OF THAT ENTITY.

PRIVACY ACT
THE SECRETARY OF TRANSPORTATION AUTHORIZED THE COAST GUARD TO BE THE AGENCY WHICH (A) ACCEPTS
APPLICATIONS FOR DOCUMENTATION OF VESSELS; (B) DETERMINES WHETHER A VESSEL WHICH IS THE SUBJECT OF
APPLICATION IS ELIGIBLE FOR THE ENDORSEMENT OR ENDORSEMENTS REQUESTED; AND (C) ISSUES CERTIFICATES OF
DOCUMENTATION TO ELIGIBLE VESSELS. (14 U.S.C. 664; 31 U.S.C. 9701; 42 U.S.C. 9118; 46 U.S.C. 2103, 2107,2110; 46 U.S.C.
APP. 841A, 876; 49 U.S.C. 332; 49 C.F.R. 1.46)
INFORMATION COLLECTED MAY BE ACCESSED BY FEDERAL, STATE, AND LOCAL AGENCIES, AS WELL AS MEMBERS OF THE
GENERAL PUBLIC TO ASSIST LAW ENFORCEMENT OR FOR OTHER LAWFUL PURPOSES. THIS INFORMATION IS ALSO
PUBLISHED IN ACCORDANCE WITH 46 U.S.C. APP. 12119.
PROVIDING THE INFORMATION IS VOLUNTARY. HOWEVER, THE COAST GUARD CANNOT PROCESS YOUR APPLICATION IF
THE REQUESTED INFORMATION IS NOT COMPLETE. THE INFORMATION FURNISHED ON THE ASSOCIATED FORMS IS USED
TO ENSURE THE REQUIREMENTS FOR DOCUMENTATION ARE MET.
PENALTIES FOR PROVIDING FALSE STATEMENTS OR REPRESENTATIONS ARE COVERED UNDER 18 U.S.C. 1001 AND 46
U.S.C. 12122.

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 10 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 (16250027), WASHINGTON, DC 20503.