Signature by or on behalf of the vessel owner(s) and acknowledged by a notary public Addresses of both the mortgagor and mortgagee Must cover the “whole” of the vessel; cite a definite amount, identify the vessel by name, official number and/or hull number A mortgage cannot be accepted for filing unless the vessel has a valid Certificate of Documentation or an Application for Initial, Exchange or Replacement, CG-1258, on file at the NVDC. 1. VESSEL NAME AND OFFICIAL NUMBER (OR OTHER UNIQUE IDENTIFIER) 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.)2. INSTRUMENT TYPE (CHECK ALL THAT APPLY) PREFERRED MORTGAGE CHATTEL MORTGAGE AMENDMENT SUPPLEMENT SUBORDINATION ASSIGNMENT OTHER Describe 3. NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES. INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED) 4. NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)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.PERCENTAGE OF VESSEL MORTGAGED OR MORTGAGE ASSIGNED (100% UNLESS OTHERWISE STATED) 5. AMOUNT 6. IDENTIFICATION ON INSTRUMENT ASSUMED, ASSIGNED, AMENDED, SUPPLEMENTED, SUBORDINATED, OR, OTHERWISE MODIFIED: 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.RECORDED BOOK: PageFILE/RECORDED DATE: MM slash DD slash YYYY TIME: OTHER IDENTIFYING DATA: Digital Signature of Owner or person acting for Owner*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. PREFERRED SHIP MORTGAGE Price: Please select any additional services you wish to have processed Priority Request/Rush Processing Abstract of Title Certified copy of COD Satisfaction of Mortgage SATISFACTION OF MORTGAGEINSTRUMENT TYPE (CHECK ALL THAT APPLY) PREFERRED MORTGAGE CHATTEL MORTGAGE AMENDMENT ASSUMPTION SUPPLEMENT SUBORDINATION ASSIGNMENT OTHER (DESCRIBE) Describe NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES. INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED) NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)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.PERCENTAGE OF VESSEL MORTGAGED OR MORTGAGE ASSIGNED (100% UNLESS OTHERWISE STATED) Amount IF THE FOLLOWING INFORMATION IS UNKNOWN YOU MUST ORDER AN ABSTRACT OF TITLE UNDER ADDITIONAL SERVICES TOWARDS THE TOP OF THE PAGE. RECORDED BOOK: Page FILE/RECORDED DATE: MM slash DD slash YYYY TIME: OTHER IDENTIFYING DATA: USCG RENEWAL DOCUMENTATION ADVANCED PAYMENT OPTIONEliminate the possibility of late fees and reinstatement fees by paying your yearly renewal documentation in advance. Your certificate of documentation will be automatically renewed each year, per the number of years selected, by Vessel Documentation Online LLC. NOTE: The NVDC only issues their vessel renewals for a period/duration of one year each. Your yearly certificate will be valid for one year only. You will receive one (1) Year long certificate each year, depending on how many additional years you have ordered. For each individual year of renewal a new renewal will be AUTOMATICALLY forwarded to your designated address at time of renewal(s). This may require that the vessel owner update their current address to facilitate the renewal process. 1 year renewal (additional $70.00) 2 year renewal (additional $140.00) 3 year renewal (additional $210.00) 4 year renewal (additional $280.00) 5 year renewal (additional $350.00) Total $0.00 Signature*Authorization* I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected USCG documents. I understand that my application will be processed in the order in which it is received by Vessel Documentation Online, a private fee for service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Vessel Documentation Online's no refund policy and as per 46 CFR 67.500(e). I understand that submitting another application for vessel documentation will supersede the current/pending application for that vessel. CAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER) Credit CardCard Details Cardholder Name Having Trouble? Check this box to move forward without your Credit Card *My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment BILLING ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name* First Last Email* Enter Email Confirm Email Phone*By clicking submit you agree to these Terms and Conditions and the above authorization of payment.Agree to Terms and Conditions* I agree to the terms and conditions below: By: wddevelopers | July 5, 2016
