CG-1261 (05/20) Builder's Certification and First Transfer of Title

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard
BUILDER’S CERTIFICATION AND FIRST TRANSFER OF TITLE

OMB No: 1625-0027
Expires: 04/30/2023

I. PHASE OF CONSTRUCTION COVERED BY THIS CERTIFICATE
YEAR PHASE OF CONSTRUCTION

ENTIRE CONSTRUCTION
HULL ONLY

YEAR COMPLETED

COMPLETION ONLY (HULL BUILT BY ANOTHER)

II. VESSEL DATA
A. HULL IDENTIFICATION NUMBER OR HULL NUMBER

B. VESSEL NAME (IF KNOWN)

C. EQUIPPED WITH ENGINE

D. PLACE OF BUILD (CITY, STATE, COUNTRY)

YES

NO

OUTBOARD:

YES

NO

E. HULL MATERIAL
WOOD

STEEL

ALUMINUM

FIBROUS REINFORCED PLASTIC

CONCRETE

OTHER

III. DIMENSIONS
(COMPLETE APPROPRIATE DIAGRAM(S) - DIMENSIONS IN FEET AND TENTHS/INCHES)

DISTINCT KEEL

FAIRED KEEL

IV. 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.
CG-1261 (05/20)

PREVIOUS EDITION OBSOLETE

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V. NAME(S) AND ADDRESS(ES) OF PARTY(IES) FOR WHOM BUILT

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

COMMUNITY PROPERTY

TENANCY BY THE ENTIRETIES

OTHER (Describe) -->

VI. CERTIFICATION
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:___________________________________________________________ OR
(NAME OF COMPANY)
AM AN EMPLOYEE OF THE COMPANY WHO BUILT VESSEL AND HAVE EXAMINED THE RECORDS OF THE COMPANY CONCERNING
THE FACTS OF BUILD OF THE VESSEL IN MY CAPACITY AS
____________________________________ OF _______________________________________________________________________
(TITLE)
(NAME OF COMPANY)
NOTE: THIS CERTIFICATE MUST NOT
BE COMPLETED BY AN IMPORTER OR
AN IMPORTER'S AGENT.

________________________________________________________________
(SIGNATURE)

_______________
(DATE)

VII. FIRST SALE OR TRANSFER OF VESSEL
100% OF THE VESSEL IDENTIFIED HEREIN IS SOLD (TRANSFERRED) BY THE PARTY(IES) NAMED IN SECTION V TO THE FOLLOWING
PERSON(S) (NAMES AND ADDRESSES)

IF SOLD (TRANSFERRED) TO MORE THAN ONE PERSON, THE PURCHASER(S) (TRANSFEREE(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

COMMUNITY PROPERTY

TENANCY BY THE ENTIRETIES

OTHER (Describe) -->

VIII. SIGNATURES OF SELLER(S) (TRANSFEROR(S)) OR PERSONS SIGNING ON BEHALF OF SELLER(S) (TRANSFEROR(S))
DATE SIGNED:
IX. NAME(S) OR PERSON(S) SIGNING ABOVE, AND LEGAL CAPACITY IN WHICH SIGNED (E.G. OWNER, AGENT,TRUSTEE, EXECUTOR)

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

STATE:_______________________________________
COUNTY:_____________________________________
_____________________________________________
NOTARY PUBLIC
MY COMMISSION EXPIRES:

PRIVACY ACT STATEMENT

1. AUTHORITY: 46 U.S.C. CHAPTER 121, DOCUMENTATION OF VESSELS AND 46 CFR PART 67, DOCUMENTATION OF VESSELS.
2. PURPOSE: TO PROVIDE BUILD INFORMATION, DIMENSIONS AND PARTY FOR WHOM BUILT.
3. ROUTINE USES: AUTHORIZED USCG PERSONNEL WILL USE THIS INFORMATION TO VALIDATE U.S. BUILD AND DETERMINE VESSEL MEETS
THE FIVE NET TON REQUIREMENT FOR DOCUMENTATION. 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.
4. 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 IN A SPECIFIC TRADE.
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: U.S. COAST GUARD, NATIONAL VESSEL DOCUMENTATION CENTER, 792 TJ
JACKSON DRIVE, FALLING WATERS, WEST VIRGINIA 25419, OR OFFICE OF MANAGEMENT AND BUDGET, OFFICE OF MANAGEMENT AND BUDGET, PAPERWORK
REDUCTION PROJECT (1625-0027), WASHINGTON, DC 20503.

CG-1261 (05/20)

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