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DEPARTMENT OF HOMELAND SECURITY OMB No 1625-0027 U.S. Coast Guard BILL OF SALE Expires 07/31/2019 1. CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION VOLUNTARY. HOWEVER FAILURE TO PROVIDE THE REQUESTED INFORMATION COULD PREVENT THE BILL OF SALE FROM BEING FILED. FURTHERMORE BILLS OF SALE WHICH ARE NOT FILED ARE DEEMED INVALID AGAINST ANY PERSON EXCEPT THE GRANTOR OR A PERSON HAVING ACTUAL KNOWLEDGE OF THE SALE. 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 20 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. STATE COUNTY NOTARY PUBLIC MY COMMISSION EXPIRES CG-1340 08/16 Previous Edition Obsolete Page 1 of 2 Reset VESSEL DATA COMPLETE THIS SECTION ONLY IF VESSEL HAS NEVER BEEN DOCUMENTED AND DOES NOT HAVE A HULL IDENTIFICATION NUMBER. A. VESSEL NAME 2. OFFICIAL NUMBER OR HULL ID NUMBER 3. NAME S AND ADDRESS ES OF SELLERS 3A. TOTAL INTEREST OWNED IF LESS THAN 100 4B. MANNER OF OWNERSHIP. UNLESS OTHERWISE STATED HEREIN THIS BILL OF SALE CREATES A TENANCY IN COMMON WITH EACH TENANT OWNING AN EQUAL UNDIVIDED INTEREST. INSERT NAMES AND ADDRESSES OF ALL PERSONS SELLING VESSEL ALONG WITH TOTAL INTEREST OWNED BY THOSE PERSONS. IF MORE ROOM IS NEEDED AN ATTACHMENT MAY BE MADE SHOWING THE ADDRESSES OF THE SELLERS. 3A. SELF-EXPLANATORY. DIVISION OF INTEREST IS SHOWN THIS BILL OF SALE WILL RESULT IN EACH BUYER HOLDING AN EQUAL INTEREST. SELF-EXPLANATORY. DIVISION OF INTEREST IS SHOWN THIS BILL OF SALE WILL RESULT IN EACH BUYER HOLDING AN EQUAL INTEREST. IF MORE ROOM IS NEEDED AN 4B. CHECK ONE OF THE BLOCKS TO CREATE A FORM OF OWNERSHIP OTHER THAN A TENANCY IN COMMON. IF OTHER IS CHECKED THE FORM OF OWNERSHIP MUST BE DESCRIBED. 5. OPTIONAL IF THE AMOUNT PAID FOR THE VESSEL IS INSERTED IT WILL BE NOTED ON THE VESSEL S GENERAL INDEX. SOLD WITH THE VESSEL. 8. SHOW THE DATE ON WHICH THE INSTRUMENT IS SIGNED. 9. IN ADDITION TO THE PRINTED OR TYPED NAME OF THE SIGNER SHOW WHETHER THAT PERSON WAS ACTING AS AN OWNER AS AN AGENT FOR AN OWNER AS TRUSTEE AS THE PERSONAL REPRESENTATIVE OR EXECUTOR OF AN ESTATE OR OTHER CAPACITY WHICH ENTITLED THAT PERSON TO SIGN THE BILL OF SALE. 10. CHAPTER 121. ROUTINE USES AUTHORIZED USCG PERSONNEL WILL USE THIS INFORMATION TO VALIDATE THE SALE AND TO DEVELOP STATISTICAL DATA RELATED TO DOCUMENTED VESSELS. ANY DISCLOSURES OF DATA WITHIN THIS RECORD WILL BE MADE IN ACCORDANCE 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 COULD PREVENT THE BILL OF SALE FROM BEING FILED.

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