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U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-5397 (Rev. 6-04)

APPLICATION FOR SIMPLIFIED MEASUREMENT
Use this form to apply to the National Vessel Documentation Center for tonnage assignment under the Simplified Measurement System I. APPLICABILITY

OMB APPROVED 1625-0022

A vessel is eligible to be measured under the Simplified Measurement System if it is either: 1) under 79 feet in overall length; or 2) a non-selfpropelled or recreational vessel. NOTE: Some vessels that are 79 feet or over in overall length may also require measurement under the Convention Measurement System. This includes vessels that engage on foreign voyages, as well as recreational vessels that engage on voyages outside the Great Lakes and have keel laid dates after December 31, 1985.

II. VESSEL DATA AND DIMENSIONS
1. VESSEL NAME 2. HULL I.D. NO. (also provide Official Number, if available) 3. HULL MATERIAL: Wood Aluminum Steel Concrete FRP (Fiberglass) Other Structure Length (Ls ) = Structure Breadth (Bs ) = Structure Depth (Ds ) = 7. ADDITIONAL DIMENSIONS FOR LARGE DECK STRUCTURES: (Complete only if the volume of the principal deckhouse, cabin or similar structure above the main deck exceeds the hull volume) ft ft ft in in in

4. PROPULSION MACHINERY: Located inside hull (e.g. inboard engine or stern drive) Located entirely outside hull (e.g. outboard motor) Non-self-propelled (not fitted with any propulsion machinery) 5. SHAPE OF HULL(s): (for tri-hull vessels, check the block best describing the center hull) Powerboat, ship or circular Sailboat distinct keel (or no keel) 8. ADDITIONAL DIMENSION FOR TWIN HULL VESSELS: (Applies only if there is no buoyant volume in the structure that connects the hulls together.) Individual Hull Breadth (B1 ) = ft in

Box or barge 6. OVERALL DIMENSIONS: Overall Length (L) = Overall Breadth (B) = Overall Depth (D) =

Sailboat integral keel (keel is faired to hull)

9. ADDITIONAL DIMENSIONS FOR TRI-HULL VESSELS: (Applies only if there is no buoyant volume in the structure that connects the hulls together.) Center Hull Length (L1 ) = ft ft ft ft ft ft in in in in in in Center Hull Breadth (B ) = 1 Center Hull Depth (D) = Outer Hull Length (L 2) = Outer Hull Breadth (B2 ) = Outer Hull Depth (D ) = 1

ft ft ft

in in in

III. STATEMENT OF REPRESENTATION
I understand that, under the provisions of 46 CFR 69.25, a person making a false statement or representation in this application may be fined up to $20,000. The vessel is also liable in rem for the penalty. I certify that the information provided by me in answering the questions above is correct. Owner's printed name Owner's signature Date

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Reverse of CG-5397 (Rev. 6-04) OVERALL DIMENSIONS LENGTH (L) is the horizontal distance between the outboard side of the foremost part (bow) of the hull and the outboard side of the aftermost part (stern) of the hull. It does not include bowsprits, rudders, outboard motor brackets, swim platforms that do not contain buoyant volume, and other similar fittings and attachments that are not part of the buoyant hull envelope. BREADTH (B) is the horizontal distance taken at the widest part of the hull, excluding rub rails, from the outboard side of the skin (outside planking or plating) on one side of the hull to the outboard side of the skin on the other side of the hull. DEPTH (D) is the vertical distance taken at or near amidships from a line drawn horizontally through the uppermost edges of the skin (outside planking or plating) at the sides of the hull (excluding the cap rail, trunks, cabins and deckhouses, and deck caps) to the outboard face of the bottom skin of the hull, excluding the keel. If your vessel is designed for sailing and the interface between the "keel" and the "bottom skin of the hull" is not at a clearly defined location (as is the case with an "integral" or "faired" keel), include the keel in the depth measurement. SIMPLIFIED MEASUREMENT PROCEDURES 1. Under Simplified measurement, a vessel must be 5 net tons or greater to be eligible for documentation (issued a Certificate of Documentation). Gross and net tonnages are measures of volume, and should not be confused with the vessel's weight, which may also be expressed in tons. 2. Gross and net tonnages are calculated by the Coast Guard using the information you provide on the front of this form. The formulas for these calculations are described in Title 46, Code of Federal Regulations (CFR), Part 69, Subpart E, and on the USCG Marine Safety Center (MSC) Web site: www.uscg.mil/hq/msc. Monohull vessels that are less than 25 feet in length are often less than 5 net tons. 3. If your vessel is eligible for documentation using Simplified measurement, complete the front side of this form by printing or typing all required information. Provide dimensions in terms of feet and inches (to the nearest inch). After signing the form, send it to the USCG National Vessel Documentation Center (NVDC) along with application form CG-1258. Only the front side of this form need be submitted to the NVDC. Please notify the NVDC if your vessel will also be measured under the Convention system (as for vessels 79 feet or over in convention length engaged on foreign voyages). 4. If all applicable requirements are met for documentation, the NVDC will issue a Certificate of Documentation with the gross and net tonnage indicated on the certificate. 5. Other U.S. tonnage measurement systems, known as "formal" measurement systems, may yield different tonnages and may be used in lieu of Simplified measurement. Formal measurement requires the employment of a USCG authorized measurement organization and a physical inspection of the vessel by that organization's surveyor. Information on how to contact these organizations is available on the MSC Web site. MULTI-HULL VESSELS For the purposes of Simplified measurement, twin hull and tri-hull vessels are defined as only those with no buoyant volume in the structure that connects the hulls together. In other words, the cross-structure, bridging, platform or "trampoline" connecting the hulls has no measurable depth or buoyancy as shown in the illustrations in Section II, Items 8 and 9 of this form. Cathedral hull forms and other similar configurations with no distinct separation of hulls are not considered multi-hulls in this context. NOVEL/UNIQUE CRAFT Certain novel or unique craft cannot be identified or categorized in the types described on the front of this form. If your vessel is in this category, you should complete Section II, Items 1-4, and Section III of this form and send the for m, along with sketches, dr awings and/or photogr aphs showing the vessel geometr y and over all dimensions, to the USCG Mar ine Safety Center (MSC) at the addr ess listed below. Send For m CG-1258 and all other information r equir ed for vessel documentation to the NVDC, notifying them of your tonnage data submission to the MSC.
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 2 hours. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commanding Officer, U.S. Coast Guard Marine Safety Center, 400 7th Street, S.W., Washington, DC 20590-0001, or Office of M anagem ent and Budget, Paperwork Reduction Project (1625-0022), Washington, DC 20503.