Free CG4593.PDF - Federal

OMB APPROVED 1625-0027

U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-4593 (Rev. 6-04)

APPLICATION, CONSENT, AND APPROVAL FOR WITHDRAWAL OF APPLICATION FOR DOCUMENTATION OR EXCHANGE OF CERTIFICATE OF DOCUMENTATION
I. APPLICATION 2. OFFICIAL NUMBER OR OTHER UNIQUE IDENTIFIER

THIS SECTION FOR COAST GUARD USE ONLY

PORT: DATE: FEE: SIGNATURE
APPROVAL GRANTED FOR EXCHANGE OF OUTSTANDING CERTIFICATE OF DOCUMENTATION OR WITHDRAWAL OF APPLICATION.

1. NAME OF VESSEL

3. NAME(S) AND ADDRESS(ES) OF MORTGAGOR(S)

4. NAME(S) AND ADDRESS(ES) OF MORTGAGEE(S)

5. DATE OF MORTGAGE

6. AMOUNT OF MORTGAGE

7. DATE FILED

8. PURPOSE OF APPLICATION APPLICATION IS HEREBY MADE FOR APPROVAL OF WITHDRAWAL OF THE APPLICATION FOR (EXCHANGE OF) DOCUMENTATION DATED: APPLICATION IS HEREBY MADE FOR APPROVAL OF EXCHANGE OF THE OUTSTANDING CERTIFICATE OF DOCUMENTATION FOR THE ABOVE NAMED VESSEL FOR THE FOLLOWING REASONS: THE MORTGAGE WILL REMAIN A VALID OBLIGATION ENFORCEABLE AGAINST THE VESSEL IN ACCORDANCE WITH ITS TERMS. 9. SIGNATURE OF OWNER OR PERSON ACTING FOR OWNER:

DATE:

II. CONSENT AS (ON BEHALF) OF THE MORTGAGEE(S), I (WE) CONSENT TO WITHDRAWAL OF THE APPLICATION FOR DOCUMENTATION OR EXCHANGE OF THE OUTSTANDING CERTIFICATE OF DOCUMENTATION.

MORTGAGEE: TITLE: DATE: PREVIOUS EDITION OBSOLETE

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Page 2 of CG-4593 (Rev. 6-04) INSTRUCTIONS I. APPLICATION 1. 2. 3. 4. 5. 6. 7. 8. 9. INDICATE CURRENT DOCUMENTED NAME. INDICATE OFFICIAL NUMBER AWARDED TO VESSEL OR OTHER UNIQUE IDENTIFIER (E.G., HULL IDENTIFICATION NUMBER). SELF-EXPLANATORY. SELF-EXPLANATORY. SELF-EXPLANATORY. SELF-EXPLANATORY. INSERT DATE MORTGAGE WAS FILED WITH USCG. SELF-EXPLANATORY. SELF-EXPLANATORY.

II. CONSENT 1. SELF-EXPLANATORY.

PRIVACY ACT STATEMENT IN ACCORDANCE WITH 5 USC 552(A), THE FOLLOWING INFORMATION IS PROVIDED TO YOU WHEN SUPPLYING PERSONAL INFORMATION TO THE U.S. COAST GUARD. 1. AUTHORITY, SOLICITATION OF THIS INFORMATION IS AUTHORIZED BY 46 USC, CHAPTER 313 AND 46 CFR, PART 67. 2. THE PRINCIPAL PURPOSES FOR WHICH THIS INSTRUMENT IS TO BE USED ARE: (A) TO PROVIDE A RECORD, AVAILABLE FOR PUBLIC INSPECTION AND COPYING, OF THE SALE OR OTHER CHANGE IN OWNERSHIP OF A VESSEL WHICH IS DOCUMENTED, WILL BE DOCUMENTED, OR HAS BEEN DOCUMENTED PURSUANT TO 46 USC, CHAPTER 121. (B) PLACEMENT OF THIS INSTRUMENT IN A BOOK FOR EXAMINATION BY GOVERNMENTAL AUTHORITIES AND MEMBERS OF THE GENERAL PUBLIC. 3. THE ROUTINE USE WHICH MAY BE MADE OF THIS INFORMATION INCLUDES DEVELOPMENT OF STATISTICAL DATA CONCERNING DOCUMENTED VESSELS. 4. DISCLOSURE OF THE INFORMATION REQUESTED ON THIS FORM IS VOLUNTARY. HOWEVER, FAILURE TO PROVIDE THE INFORMATION COULD PRECLUDE FILING OF A BILL OF SALE AND DOCUMENTATION OF THE VESSEL NAMED HEREIN PURSUANT TO 46 USC, CHAPTER 121. MOREOVER, BILLS OF SALE WHICH ARE NOT FILED ARE NOT DEEMED TO BE VALID AGAINST ANY PERSON EXCEPT THE GRANTOR OR A PERSON HAVING ACTUAL KNOWLEDGE OF THE SALE. (46 USC 31321(A)). THE COAST GUARD ESTIMATES THAT THE AVERAGE BURDEN FOR THIS FORM IS 10 MINUTES. YOU MAY SUBMIT ANY COMMENTS CONCERNING THE ACCURACY OF THIS BURDEN ESTIMATE OR MAKE SUGGESTIONS FOR REDUCING THE BURDEN TO: COMMANDANT (G-MV), U.S. COAST GUARD, WASHINGTON, DC 20593-0001 OR OFFICE OF MANAGEMENT AND BUDGET, OFFICE OF INFORMATION AND REGULATORY AFFAIRS, ATTENTION: DESK OFFICER FOR DHS/USCG, OLD EXECUTIVE OFFICE BUILDING, WASHINGTON, DC 20503.