CG-4593 Application, Consent, and Approval for Withdrawal of App

DEPARTMENT OF HOMELAND SECURITY

OMB No: 1625-0027

U.S. Coast Guard
Expires: 06/30/2016
APPLICATION, CONSENT, AND APPROVAL FOR WITHDRAWAL OF APPLICATION FOR
DOCUMENTATION OR EXCHANGE OF CERTIFICATE OF DOCUMENTATION
I. APPLICATION
1. VESSEL NAME

2. OFFICIAL NUMBER OR OTHER UNIQUE
IDENTIFIER

3. NAME(S) AND ADDRESS(ES) OF MORTGAGOR(S)

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

5. DATE OF MORTGAGE

6. AMOUNT OF MORTGAGE

7. DATE FILED

8. PURPOSE OF APPLICATION
APPLICATION IS HEREBY MADE FOR APPROVAL OF WITHDRAWAL OF THE APPLICATION FOR (EXCHANGE OF) DOCUMENTATION
DATED: ________________________________
APPLICATION IS HEREBY MADE FOR APPROVAL OF EXCHANGE OF THE OUTSTANDING CERTIFICATE OF DOCUMENTATION FOR THE
ABOVE NAMED VESSEL FOR THE FOLLOWING REASONS:
___________________________________________________________________________________________________________
THE MORTGAGE WILL REMAIN A VALID OBLIGATION ENFORCEABLE AGAINST THE VESSEL IN ACCORDANCE WITH ITS TERMS.

9. SIGNATURE OF OWNER OR PERSON ACTING FOR OWNER

DATE

II. CONSENT
AS (ON BEHALF) OF THE MORTGAGEE(S), (WE) CONSENT TO WITHDRAWAL OF THE APPLICATION FOR DOCUMENTATION OR EXCHANGE OF
THE OUTSTANDING CERTIFICATE OF DOCUMENTATION.

MORTGAGEE: ___________________________________________________

TITLE: _________________________________________________________

DATE: _________________________________________________________

CG-4593 (06/12)

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INSTRUCTIONS
I. APPLICATION
1. INDICATE CURRENT DOCUMENTED NAME.
2. INDICATE OFFICIAL NUMBER AWARDED TO VESSEL OR OTHER UNIQUE IDENTIFIER (E.G., HULL IDENTIFICATION NUMBER).
3. SELF-EXPLANATORY.
4. SELF-EXPLANATORY.
5. SELF-EXPLANATORY.
6. SELF-EXPLANATORY.
7. INSERT DATE MORTGAGE WAS FILED WITH USCG.
8. SELF-EXPLANATORY.
9. SELF-EXPLANATORY.

II. CONSENT
1. SELF-EXPLANATORY

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 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 (1625-0027), WASHINGTON, DC 20503.

CG-4593 (06/12)

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