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NOTE When applying for Fishery and/or Coastwise endorsement s see item 5. READ THE PRIVACY ACT STATEMENT AT THE END OF THE CG-1258. INSTRUCTIONS FOR COMPLETING FORM CG-1258 A. VESSEL NAME Insert name by which you wish the vessel to be known. If applying to change the vessel s name insert the old vessel name in parenthesis. PRIMARY SERVICE HORSEPOWER HORSEPOWER OFFSHORE SUPPLY VESSEL COMMERCIAL FISHING BOAT PASSENGER 6 OR FEWER RESEARCH VESSEL FISH PROCESSING VESSEL PASSENGER MORE THAN 6 SCHOOL SHIP FREIGHT SHIP PASSENGER BARGE 6 OR FEWER TANK BARGE FREIGHT BARGE TANK SHIP INDUSTRIAL VESSEL PUBLIC FREIGHT TOWING VESSEL MOBILE OFFSHORE DRILLING UNIT PUBLIC TANKSHIP/BARGE UNCLASSIFIED VESSEL OIL RECOVERY PUBLIC VESSEL UNC CG-1258 08/16 Previous Edition Obsolete Page 1 of 4 Reset L. CITIZENSHIP OF OWNER CHECK THE BOX ES TO SHOW THE TYPE S OF ENTITY IES THAT OWNS THE VESSEL ONE OR MORE INDIVIDUALS I WE CERTIFY THAT ALL OWNERS OF THIS VESSEL ARE CITIZENS OF THE UNITED STATES GOVERNMENT ENTITY FEDERAL STATE TERRITORY POSSESSION OR SUBDIVISION CORPORATION SEE SECTION M ITEM 5 WHEN APPLYING FOR A FISHERY OR COASTWISE 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. 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 S 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 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. Only standard Alpha and Numeric Characters in the vessel name will appear on the Certificate of Documentation. Click icon for attachment if application covers multiple vessels. B. OFFICIAL NUMBER Insert the Official Number O/N awarded by the Coast Guard for all but Initial Issue cases. C. HULL ID Insert Hull Identification Number HIN as assigned in accordance with 33 CFR 81. D. IMO Insert International Maritime Organization Number IMO if any. DEPARTMENT OF HOMELAND SECURITY OMB No 1625-0027 U.S. Coast Guard APPLICATION FOR INITIAL EXCHANGE OR REPLACEMENT OF CERTIFICATE OF DOCUMENTATION REDOCUMENTATION Expires 07/31/2019 NOTE FILING THIS APPLICATION DOES NOT ENTITLE A VESSEL TO DOCUMENTATION OR TO ANY CHANGES SOUGHT ON A CERTIFICATE OF DOCUMENTATION. OFFICIAL NUMBERS DESIGNATED ON THE BASIS OF THIS APPLICATION ARE NOT TRANSFERABLE. ONLY A CURRENT COMPLETE FOR ALL APPLICATIONS A. 113 TIN MAILING ADDRESS OF MANAGING OWNER IF DIFFERENT THAN H. NAME S OF OTHER OWNER S I. PURPOSE OF APPLICATION 1. EXCHANGE OF CERTIFICATE OF DOCUMENTATION. 2. REPLACEMENT OF LOST WRONGFULLY WITHHELD OR MUTILATED CERTIFICATE OF DOCUMENTATION. 3. RE-INSTATEMENT OF CERTIFICATE OF DOCUMENTATION FOLLOWING FAILURE TO RENEW. 4. RETURN TO DOCUMENTATION FOLLOWING DELETION. VESSEL NAME WHEN LAST DOCUMENTED WAS BUILT AT IN OR CITY STATE COUNTRY MONTH/YEAR IS UNDER CONSTRUCTION AT AND IS SCHEDULED FOR COMPLETION IN HULL MATERIAL WOOD STEEL FIBROUS REINFORCED PLASTIC ALUMINUM CONCRETE OTHER DESCRIBE APPROXIMATE LENGTH OF VESSEL PREVIOUS NAMES NUMBERS OR FOREIGN REGISTRATIONS OF VESSEL J. ENDORSEMENTS FOR WHICH APPLICATION IS MADE RECREATIONAL COASTWISE BOWATERS ONLY CERTIFICATE ON FILE FISHERY COASTWISE OIL SPILL RESPONSE ONLY LETTER OF QUALIFICATION ON FILE COASTWISE COASTWISE UNDER CHARTER TO AN ENTITY QUALIFIED TO ENGAGE IN COASTWISE TRADE REGISTRY COPY OF CHARTER ON FILE K. IMO IF ANY E. HAILING PORT INCLUDING STATE TO BE MARKED ON VESSEL SOCIAL SECURITY OR TAX ID NUMBER REQUIRED 46 USC 12104 F. NAME OF MANAGING OWNER SSN E-MAIL ADDRESS TELEPHONE NUMBER G. PHYSICAL ADDRESS OF MANAGING OWNER REQUIRED 46 CFR 67. 113 TIN MAILING ADDRESS OF MANAGING OWNER IF DIFFERENT THAN H. NAME S OF OTHER OWNER S I. PURPOSE OF APPLICATION 1. EXCHANGE OF CERTIFICATE OF DOCUMENTATION. 2. REPLACEMENT OF LOST WRONGFULLY WITHHELD OR MUTILATED CERTIFICATE OF DOCUMENTATION. 3.