CG-1280 (05/16) Vessel Renewal Notification Application for Renewal

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard
VESSEL RENEWAL NOTIFICATION
APPLICATION FOR RENEWAL
RETURN TO:

OMB No: 1625-0027
Form Expires: 07/31/2019

NATIONAL VESSEL DOCUMENTATION CENTER
PO BOX 1119
FALLING WATERS, WV 25419-1119

NOTICE: A FEE OF $26 PER VESSEL IS REQUIRED TO RENEW CURRENT CERTIFICATES OF DOCUMENTATION (CODS).
RENEWAL REQUESTS RECEIVED UP TO 30 DAYS AFTER THE EXPIRATION DATE OF THE COD WILL BE CONSIDERED 'LATE' AND WILL
REQUIRE PAYMENT OF A $5 LATE FEE (TOTAL PAYMENT OF $31.00).
RENEWAL REQUESTS RECEIVED 31 DAYS AFTER THE EXPIRATION DATE OF THE COD WILL RESULT IN THE COD BEING 'EXPIRED' AND WILL
REQUIRE REINSTATEMENT, WITH A PAYMENT OF $84.00. FOR MORE INFORMATION ON REINSTATEMENT, VISIT OUR WEBSITE AT
www.uscg.mil/nvdc
INSTRUCTIONS AND FORMS
REPLACEMENT AND REINSTATEMENT DOCUMENTATION.
PAYMENT OPTIONS
1. PAY ONLINE (single vessels only): To pay electronically, visit our website at www.uscg.mil/nvdc
Order Products Online
Renew (or Late Renewal) and
follow instructions. You will need your Official Number to complete the payment process.
CUSTOMERS WHO PAY ONLINE ARE NOT REQUIRED TO SUBMIT A SEPARATE CG-1280.
2. PAY BY CREDIT CARD, CHECK OR MONEY ORDER (single vessels and/or Fleets): If paying by credit card, submit completed CG-1280 and CG-7042
AUTHORIZATION FOR CREDIT CARD TRANSACTIONS. If paying by check or money order, submit completed CG-1280 and check or money order payable
to: U.S. Coast Guard
COMPLETING THE CG-1280:
1. If the CG-1280 was mailed to you, sign, date and indicate Capacity of Person signing. Enter change of address information if applicable.
2. If you obtained a blank, fillable form from our website, insert name and address in upper left corner of form to the left of the NVDC return address. Enter change
of address information below, if applicable. Sign, date, indicate Capacity of Person signing AND enter Vessel Name and Official Number in block titled VESSEL
NAME AND OFFICIAL #.
NOTE: Contact the National Vessel Documentation Center at (800) 799-8362 or (304) 271-2400 Eastern Standard Time to make any change other than address.
Mail completed form and payment to the address listed above, or e-mail to [email protected]
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 ANY 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 20593.
PLEASE INDICATE ADDRESS CHANGE BELOW, IF ANY. (A PHYSICAL ADDRESS IS REQUIRED WHEN USING A POST OFFICE BOX.)
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 121 AND 46 CFR, PART 67.
2. PRINCIPAL PURPOSE FOR WHICH THIS INFORMATION IS TO BE USED IS TO RENEW CERTIFICATES OF DOCUMENTATION AND/OR CHANGE OF ADDRESS, IF APPLICABLE.
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 IN A SPECIFIED TRADE.

NAME

E-MAIL ADDRESS

PHYSICAL ADDRESS

P.O. BOX

CITY, STATE, ZIP

CITY, STATE, ZIP

POTENTIAL PENALTIES FOR FALSE STATEMENTS OR REPRESENTATION BY OWNER OR REPRESENTATIVE: VESSEL FORFEITURE (46 USC 12151) & FINE AND/OR IMPRISONMENT (18 USC 1001).

I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS,
ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME. CONTACT THE
NATIONAL VESSEL DOCUMENTATION CENTER FOR ANYTHING OTHER THAN CHANGE OF ADDRESS.

VESSEL NAME AND OFFICIAL #
AUTHORIZED SIGNATURE

CAPACITY OF PERSON SIGNING (OWNER/AGENT)

CG-1280 (05/16)

DATE

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