Free CG2633.pdf - Federal


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Date: November 20, 2007
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State: Federal
Category: Government
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U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-2633 (Rev. 11-07)

APPLICATION FOR WAIVER AND WAIVER ORDER
SECTION I - APPLICATION

Form Approved OMB No. 1625-0002

NAME OF VESSEL NAME OF OPERATOR WAIVER REQUESTED

OFFICIAL NO. VESSEL'S EMPLOYMENT

EXTENT TO WHICH WAIVER WILL AFFECT SAFETY OF VESSEL

REASONS JUSTIFYING WAIVER

I HEREBY CERTIFY that in my opinion waiver of compliance with the requirements of law or regulation specified above is necessary in the interest of national defense. WAIVER REQUESTED FOR PERIOD APPLICANT'S TITLE SIGNATURE DATE

SECTION II WAIVER ORDER
(To be filled in by Issuing Officer) IDENTIFICATION DATA (To be filled only if different from information on application) PERIOD COVERED BY WAIVER

REQUIREMENTS WAIVER

CONDITIONAL PROVISIONS

THIS IS TO CERTIFY that pursuant to the above application a waiver of the requirements of the navigation and vessel inspection laws administered by the Coast Guard is hereby made effective to the vessel named above in the interest of National Defense to the extent, for the period, and under the conditions set forth above. PLACE DATE

TITLE OF ISSUING OFFICER

SIGNATURE

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 report is 30 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (G-MOC), U.S. Coast Guard, Washington, DC 20593-0001, or Office of Management and Budget, Paperwork Reduction Project (1625-0002), Washington, DC 20503. U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-2633 (Rev. 11-07)

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