CG-1258 Attachment Application for Initial Issue, Exchange, or Replacement

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard
APPLICATION FOR INITIAL ISSUE, EXCHANGE, OR REPLACEMENT OF CERTIFICATE OF
DOCUMENTATION; REDOCUMENTATION
SECTION L – ATTACHMENT TO LIMITED LIABILITY COMPANY
OFFICIAL NUMBER (IF AWARDED)

HULL IDENTIFICATION NUMBER (IF ANY)

MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME
MEMBER’S NAME

MEMBER’S NAME

PRIVACY ACT STATEMENT
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AUTHORITY: 46 U.S.C. CHAPTER 121, DOCUMENTATION OF VESSELS AND 46 U.S.C. CHAPTER 125, VESSEL IDENTIFICATION SYSTEM; 46 U.S.C. § 50501, ENTITIES
DEEMED CITIZENS OF THE UNITED STATES.
PURPOSE: TO VALIDATE CITIZENSHIP OF THE OWNER OF THE VESSEL FOR WHICH APPLICATION FOR DOCUMENTATION IS MADE, TO DETERMINE ELIGIBILITY
OF THE VESSEL TO BE DOCUMENTED WITH THE PREFERRED TRADE ENDORSEMENT, AND TO PUBLISH INFORMATION RELATED TO U.S. DOCUMENTED
VESSELS.
ROUTINE USES: AUTHORIZED USCG PERSONNEL WILL UTILIZE THIS INFORMATION TO VALIDATE CITIZENSHIP OF THE VESSEL’S OWNER AND CERTIFY
VESSEL’S ELIGIBILITY TO BE DOCUMENTED WITH THE PREFERRED TRADE ENDORSEMENT. ANY DISCLOSURES OF DATA WITHIN THIS RECORD WILL BE MADE
IN ACCORDANCE WITH DHS/USCG-013, MARINE INFORMATION FOR SAFETY AND LAW ENFORCEMENT (MISLE), 74 FEDERAL REGISTER (FR) 30305, JUNE 25, 2009.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: VOLUNTARY. HOWEVER, FAILURE TO PROVIDE THE REQUESTED INFORMATION WILL RESULT IN
DENIAL OF APPLICATION, WHICH MAY PREVENT THE OWNER FROM OPERATING THE VESSEL(S) IN A SPECIFIC TRADE.

CG-1258 (08/16)

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