Satisfaction / Release of Mortgage / Lien SATISFACTION/RELEASE OF MORTGAGE To be filed and recorded in accordance with 46 CFR, Part 67, Subpart S (67.265) Any failure to provide the U.S. Coast Guard with an acknowledged certificate of discharge of the indebtedness on full and final discharge of the indebtedness under a recorded mortgage may subject the mortgagee to a civil penalty of not more than $10,000 (46 U.S.C. 31309/31321(f)). 1. VESSEL NAME 2. OFFICIAL NUMBER OR OTHER UNIQUE IDENTIFIER PLEASE LIST COAST GUARD ASSIGNED OFFICIAL NUMBER, MANUFACTURER’S HULL IDENTIFICATION NUMBER (HIN) ASSIGNED IN ACCORDANCE WITH RULES IN 33 CFR, OR OTHER UNIQUE IDENTIFIER, (STATE MOTORBOAT NUMBERS ARE NOT CONSIDERED TO BE UNIQUE IDENTIFIERS.)3. SELECT INSTRUMENT TYPE (CHECK ALL THAT APPLY) PREFERRED MORTGAGE CHATTEL MORTGAGE AMENDMENT SUPPLEMENT SUBORDINATION ASSIGNMENT OTHER Describe 4. NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES.PLEASE SPECIFY INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED) 5. NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)GRANTEE. FOR PURPOSES OF THIS FORM, GRANTEES INCLUDE MORTGAGEES, ASSIGNEES, PERSON FROM WHOM MORTGAGES ARE ASSUMED, AND PERSON TO WHOM SUBORDINATION OF MORTGAGES ARE GRANTED. LIST ALL GRANTEES AND ADDRESSES.PLEASE SPECIFY PERCENTAGE OF VESSEL MORTGAGED OR MORTGAGE ASSIGNED (100% UNLESS OTHERWISE STATED) 6. AMOUNT IF THE FOLLOWING INFORMATION IS UNKNOWN YOU MUST ORDER AN ABSTRACT OF TITLE UNDER ADDITIONAL SERVICES.RECORDED BOOK: PageFILE/RECORDED DATE: MM slash DD slash YYYY TIME: OTHER IDENTIFYING DATA: HiddenHiddenDigital Signature of Owner or person acting for Owner Product Name Price: SATISFACTION / RELEASE OF MORTGAGE / LIEN Price: Please select any additional services you wish to add to have processed Priority Request/Rush Processing Abstract of Title Certified Copy of COD Deletion from USCG Documentation Priority Request/Rush Processing Price: Abstract of Title Price: Certified Copy of COD Price: Deletion from USCG Documentation Price: Deletion from USCG DocumentationVESSEL NAME AND OFFICIAL #* Official Number or other unique identifer (ex. HIN) Reason for Deletion*USCG RENEWAL DOCUMENTATION ADVANCED PAYMENT OPTIONYou can eliminate the possibility of late fees, as well as reinstatement fees, by paying your yearly renewal documentation in advance. Your certificate of documentation will be automatically renewed each year, for the number of years selected, by Maritime Documentation Center, a private documentation firm. NOTE: The NVDC only issues their vessel renewals for a period/duration of one year each. Your yearly certificate will be valid for one year only. You will receive one (1) Year long certificate each year, depending on how many additional years you have ordered. For each individual year of renewal a new renewal will be AUTOMATICALLY forwarded to your designated address at time of renewal(s). This may require that the vessel owner update their current address to facilitate the renewal process. No Additional Years 1 year renewal (additional $75.00) 2 year renewal (additional $150.00) 3 year renewal (additional $225.00) 4 year renewal (additional $300.00) 5 year renewal (additional $375.00) Total $0.00 AUTHORIZED SIGNATURE* SIGNATURE (TYPE FULL NAME)Signature*CAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER) Authorization* I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected USCG documents. I understand that my application will be processed in the order in which it is received by Maritime Documentation Center, a private fee for service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Maritime Documentation Center and as per 46 CFR 67.500(e). I understand that submitting another application for vessel documentation will supersede the current/pending application for that vessel. PAYMENT INFORMATION* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name HiddenHiddenHaving Trouble? Check this box to move forward without your Credit Card *My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment YOUR BILLING ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Name First Last Email* Enter Email Confirm Email Phone*(###) ###-####By clicking submit you agree to these Terms and Conditions and the above authorization of payment. By: Maritime Documentation Center | July 5, 2016