{"id":583,"date":"2016-08-09T16:43:22","date_gmt":"2016-08-09T16:43:22","guid":{"rendered":"https:\/\/vesseldocumentation.us\/?page_id=583"},"modified":"2023-11-05T17:40:25","modified_gmt":"2023-11-06T01:40:25","slug":"change-vessel-name-hailing-port","status":"publish","type":"page","link":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/","title":{"rendered":"CHANGE OF VESSEL NAME OR HAILING PORT"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_17' style='display:none'><div id='gf_17' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">CHANGE OF VESSEL NAME OR HAILING PORT<\/h2>\n                            <p class='gform_description'>VESSEL NAME OR HAILING PORT CHANGE<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_17'  action='\/nvdc\/wp-json\/wp\/v2\/pages\/583#gf_17' data-formid='17' novalidate>\n        <div id='gf_progressbar_wrapper_17' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_17_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_17_213\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<\/legend><div class='ginput_container ginput_container_consent'><input name='input_213.1' id='input_17_213_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_17_213_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_213.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_213.3' value='43' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_17_67\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"font-size:1.4rem\">Once submitted, our specialists will review your document and will\ncontact you to ensure the integrity of the submitted data. This form\nis secure, protected by SSL encryption, so your personal\ninformation is safe.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"color: red;\"><strong>ANY ADDITIONAL CHANGES APART FROM VESSEL NAME CHANGE OR HAILING PORT CHANGE WILL REQUIRE ADDITIONAL FEES.<\/strong><\/p>\n<p>&nbsp;<\/p>\nNOTE: 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 CERTIFICATE OF DOCUMENTATION IS VALID FOR VESSEL OPERATION.\n<p style=\"color:red;\">IF YOUR USCG (CERTIFICATE OF DOCUMENTATION) HAS PASSED 30 DAYS OF EXPIRATION, YOU MUST REINSTATE YOUR DOCUMENTATION. PLEASE FOLLOW THIS LINK TO <a style=\"text-decoration: none;\" href=\"https:\/\/usvesselregistrar.us\/nvdc\/reinstatement\/\">\"REINSTATE\"<\/a> YOUR (CERTIFICATE OF DOCUMENTATION)<\/p><\/div><div id=\"field_17_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_1'>A-1. CURRENT VESSEL<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_17_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_190\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_190'>A-2. NEW VESSEL NAME<\/label><div class='ginput_container ginput_container_text'><input name='input_190' id='input_17_190' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_190\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_190'>Insert name by which you wish the vessel to be known. 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.<\/div><\/div><fieldset id=\"field_17_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please select from the following:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_17_3'>\n\t\t\t<div class='gchoice gchoice_17_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='I already own this vessel'  id='choice_17_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_3_0' id='label_17_3_0' class='gform-field-label gform-field-label--type-inline'>I already own this vessel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='I purchased this vessel from another owner'  id='choice_17_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_3_1' id='label_17_3_1' class='gform-field-label gform-field-label--type-inline'>I purchased this vessel from another owner<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='This vessel was just built'  id='choice_17_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_3_2' id='label_17_3_2' class='gform-field-label gform-field-label--type-inline'>This vessel was just built<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_111\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_10\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_10'>B-1. HAILING PORT INCLUDING STATE<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_17_10' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_191\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_191'>B-2. NEW HAILING PORT INCLUDING STATE (TO BE MARKED ON VESSEL)<\/label><div class='ginput_container ginput_container_text'><input name='input_191' id='input_17_191' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_191\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_191'>Insert name of place and state exactly as it is or will be marked on the vessel. The hailing port must be a place in the United States. Commonly used abbreviations such as \u2018NY, NY\u2019 are acceptable.<\/div><\/div><div id=\"field_17_114\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_150\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_150'>C. OFFICIAL # (IF AWARDED)<\/label><div class='ginput_container ginput_container_text'><input name='input_150' id='input_17_150' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_150\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_150'>Insert the Official Number (O\/N) awarded by the Coast Guard for all but Initial Issue cases.<\/div><\/div><div id=\"field_17_151\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_6\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_6'>D. HULL ID # (IF ANY)<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_17_6' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_6\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_6'>Insert Hull Identification Number (HIN) as assigned in accordance with 33 CFR 81.<\/div><\/div><div id=\"field_17_113\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_8\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_8'>E. IMO # (IF ANY)<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_17_8' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_8\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_8'>Insert International Maritime Organization Number (IMO), if any.<\/div><\/div><div id=\"field_17_115\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_202\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Name, e-mail address, and telephone number of the owner to whom\nthe Coast Guard should send correspondence and their Social\nSecurity Number (SSN) or Tax Identication Number (TIN). Only an owner or part owner can be the\nmanaging owner. For vessels owned by a corporation the\ncorporation is the managing owner. For a trust arrangement, the\ntrustee is the managing owner. For a Partnership or a LLC, the name\nof the Partnership or the LLC should be shown.<\/div><div id=\"field_17_199\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_199'>NAME OF MANAGING OWNER<\/label><div class='ginput_container ginput_container_text'><input name='input_199' id='input_17_199' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_200\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_200'>E-MAIL ADDRESS OF MANAGING OWNER<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_200' id='input_17_200' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_17_201\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_201'>TELEPHONE NUMBER OF MANAGING OWNER<\/label><div class='ginput_container ginput_container_text'><input name='input_201' id='input_17_201' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_130\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_130'>SOCIAL SECURITY OR TAX ID NUMBER (46 USC 12104): (SECURE FORM)<\/label><div class='ginput_container ginput_container_text'><input name='input_130' id='input_17_130' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >IS THIS NUMBER YOUR SOCIAL SECURITY NUMBER OR YOUR TAX ID NUMBER?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_17_15'>\n\t\t\t<div class='gchoice gchoice_17_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='SOCIAL SECURITY NUMBER'  id='choice_17_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_15_0' id='label_17_15_0' class='gform-field-label gform-field-label--type-inline'>SOCIAL SECURITY NUMBER<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='TAX ID NUMBER'  id='choice_17_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_15_1' id='label_17_15_1' class='gform-field-label gform-field-label--type-inline'>TAX ID NUMBER<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_117\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_192\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >G. ENTER PHYSICAL ADDRESS OF MANAGING OWNER (REQUIRED \u2013 46 CFR 67.113)<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_17_192' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_17_192_1_container' >\n                                        <input type='text' name='input_192.1' id='input_17_192_1' value=''    aria-required='false'    \/>\n                                        <label for='input_17_192_1' id='input_17_192_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_17_192_2_container' >\n                                        <input type='text' name='input_192.2' id='input_17_192_2' value=''     aria-required='false'   \/>\n                                        <label for='input_17_192_2' id='input_17_192_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_17_192_3_container' >\n                                    <input type='text' name='input_192.3' id='input_17_192_3' value=''    aria-required='false'    \/>\n                                    <label for='input_17_192_3' id='input_17_192_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_17_192_4_container' >\n                                        <input type='text' name='input_192.4' id='input_17_192_4' value=''      aria-required='false'    \/>\n                                        <label for='input_17_192_4' id='input_17_192_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_17_192_5_container' >\n                                    <input type='text' name='input_192.5' id='input_17_192_5' value=''    aria-required='false'    \/>\n                                    <label for='input_17_192_5' id='input_17_192_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_17_192_6_container' >\n                                        <select name='input_192.6' id='input_17_192_6'   aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_17_192_6' id='input_17_192_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_17_192'><span style=\"display:none !important\">Enter the mailing address. If physical (street) address differs from mailing address, enter BOTH.<\/span><\/div><\/fieldset><fieldset id=\"field_17_193\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >ENTER MAILING ADDRESS OF MANAGING OWNER (IF DIFFERENT THAN PHYSICAL ADDRESS \u2013 E.G. , P.O. BOX)<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_17_193' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_17_193_1_container' >\n                                        <input type='text' name='input_193.1' id='input_17_193_1' value=''    aria-required='false'    \/>\n                                        <label for='input_17_193_1' id='input_17_193_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_17_193_2_container' >\n                                        <input type='text' name='input_193.2' id='input_17_193_2' value=''     aria-required='false'   \/>\n                                        <label for='input_17_193_2' id='input_17_193_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_17_193_3_container' >\n                                    <input type='text' name='input_193.3' id='input_17_193_3' value=''    aria-required='false'    \/>\n                                    <label for='input_17_193_3' id='input_17_193_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_17_193_4_container' >\n                                        <input type='text' name='input_193.4' id='input_17_193_4' value=''      aria-required='false'    \/>\n                                        <label for='input_17_193_4' id='input_17_193_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_17_193_5_container' >\n                                    <input type='text' name='input_193.5' id='input_17_193_5' value=''    aria-required='false'    \/>\n                                    <label for='input_17_193_5' id='input_17_193_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_17_193_6_container' >\n                                        <select name='input_193.6' id='input_17_193_6'   aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_17_193_6' id='input_17_193_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_17_119\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_203\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_203'>H. Are There Other Persons and\/or Entities That Own an Interest in the Vessel?<\/label><div class='ginput_container ginput_container_select'><select name='input_203' id='input_17_203' class='medium gfield_select'  aria-describedby=\"gfield_description_17_203\"   aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' selected='selected'>No<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_17_203'><strong>Include all persons\/entities (other than managing owner) who own an interest in the vessel below.<\/strong><\/div><\/div><div id=\"field_17_20\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_20'>H. NAME(S) OF OTHER OWNER(S)<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_17_20' type='text' value='' class='large'  aria-describedby=\"gfield_description_17_20\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_20'>All persons\/entities (other than managing owner) who own an interest in the vessel. If no owners other than the managing owner, leave blank. Click icon for attachment if application covers multiple owners.<\/div><\/div><div id=\"field_17_204\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_204'>Is there an active lien or mortgage on this vessel?<\/label><div class='ginput_container ginput_container_select'><select name='input_204' id='input_17_204' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' selected='selected'>No<\/option><\/select><\/div><\/div><div id=\"field_17_205\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_205'>Is it satisfied?<\/label><div class='ginput_container ginput_container_select'><select name='input_205' id='input_17_205' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' selected='selected'>No<\/option><\/select><\/div><\/div><div id=\"field_17_120\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I. PURPOSE OF APPLICATION.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_17_26'>Check applicable blocks to show purpose of application. If vessel has never been documented, check Block #5 and provide ALL requested information known about the vessel's place and year of build, hull material, approximate length and previous names and numbers. If this information is unknown, please indicate.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_26'><div class='gchoice gchoice_17_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='1. TRANSFER\/EXCHANGE OF CERTIFICATE OF DOCUMENTATION'  id='choice_17_26_1'   aria-describedby=\"gfield_description_17_26\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_17_26_1' id='label_17_26_1' class='gform-field-label gform-field-label--type-inline'>1. TRANSFER\/EXCHANGE OF CERTIFICATE OF DOCUMENTATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='2. REPLACEMENT OF LOST, WRONGFULLY WITHHELD OR MUTILATED CERTIFICATE OF DOCUMENTATION'  id='choice_17_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_26_2' id='label_17_26_2' class='gform-field-label gform-field-label--type-inline'>2. REPLACEMENT OF LOST, WRONGFULLY WITHHELD OR MUTILATED CERTIFICATE OF DOCUMENTATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='3. RE-INSTATEMENT OF CERTIFICATE OF DOCUMENTATION FOLLOWING FAILURE TO RENEW'  id='choice_17_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_26_3' id='label_17_26_3' class='gform-field-label gform-field-label--type-inline'>3. RE-INSTATEMENT OF CERTIFICATE OF DOCUMENTATION FOLLOWING FAILURE TO RENEW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='4. RETURN TO DOCUMENTATION FOLLOWING DELETION.'  id='choice_17_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_26_4' id='label_17_26_4' class='gform-field-label gform-field-label--type-inline'>4. RETURN TO DOCUMENTATION FOLLOWING DELETION.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_26_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.5' type='checkbox'  value='5. APPLICATION FOR OFFICIAL NUMBER AND FIRST CERTIFICATE OF DOCUMENTATION.'  id='choice_17_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_26_5' id='label_17_26_5' class='gform-field-label gform-field-label--type-inline'>5. APPLICATION FOR OFFICIAL NUMBER AND FIRST CERTIFICATE OF DOCUMENTATION.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_26_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.6' type='checkbox'  value='6. CHANGE OF VESSEL NAME OR HAILING PORT' checked='checked' id='choice_17_26_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_26_6' id='label_17_26_6' class='gform-field-label gform-field-label--type-inline'>6. CHANGE OF VESSEL NAME OR HAILING PORT<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_68\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_68'>VESSEL NAME WHEN LAST DOCUMENTED:<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_17_68' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_27\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >HULL MATERIAL:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_27'><div class='gchoice gchoice_17_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='WOOD'  id='choice_17_27_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_27_1' id='label_17_27_1' class='gform-field-label gform-field-label--type-inline'>WOOD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_27_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.2' type='checkbox'  value='STEEL'  id='choice_17_27_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_27_2' id='label_17_27_2' class='gform-field-label gform-field-label--type-inline'>STEEL<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_27_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.3' type='checkbox'  value='FIBROUS REINFORCED PLASTIC'  id='choice_17_27_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_27_3' id='label_17_27_3' class='gform-field-label gform-field-label--type-inline'>FIBROUS REINFORCED PLASTIC<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_27_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.4' type='checkbox'  value='ALUMINUM'  id='choice_17_27_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_27_4' id='label_17_27_4' class='gform-field-label gform-field-label--type-inline'>ALUMINUM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_27_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.5' type='checkbox'  value='CONCRETE'  id='choice_17_27_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_27_5' id='label_17_27_5' class='gform-field-label gform-field-label--type-inline'>CONCRETE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_27_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.6' type='checkbox'  value='OTHER'  id='choice_17_27_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_27_6' id='label_17_27_6' class='gform-field-label gform-field-label--type-inline'>OTHER<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_220\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >ENGINE LOCATION<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_17_220'>\n\t\t\t<div class='gchoice gchoice_17_220_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_220' type='radio' value='INBOARD'  id='choice_17_220_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_220_0' id='label_17_220_0' class='gform-field-label gform-field-label--type-inline'>INBOARD<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_220_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_220' type='radio' value='OUTBOARD'  id='choice_17_220_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_220_1' id='label_17_220_1' class='gform-field-label gform-field-label--type-inline'>OUTBOARD<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_155\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_155'>Describe<\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_17_155' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_116\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >J. ENDORSEMENTS FOR WHICH APPLICATION IS MADE Check the appropriate block(s) to indicate all endorsement(s) sought on this application.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_28'><div class='gchoice gchoice_17_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='RECREATIONAL'  id='choice_17_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_1' id='label_17_28_1' class='gform-field-label gform-field-label--type-inline'>RECREATIONAL<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='FISHERY &lt;font color=&quot;red&quot;&gt;(MAKE SURE TO CHECK THIS ON STEP 3 BEFORE CHECK OUT)&lt;\/font&gt;'  id='choice_17_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_2' id='label_17_28_2' class='gform-field-label gform-field-label--type-inline'>FISHERY <font color=\"red\">(MAKE SURE TO CHECK THIS ON STEP 3 BEFORE CHECK OUT)<\/font><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_28_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.3' type='checkbox'  value='COASTWISE &lt;font color=&quot;red&quot;&gt;(MAKE SURE TO CHECK THIS ON STEP 3 BEFORE CHECK OUT)&lt;\/font&gt;'  id='choice_17_28_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_3' id='label_17_28_3' class='gform-field-label gform-field-label--type-inline'>COASTWISE <font color=\"red\">(MAKE SURE TO CHECK THIS ON STEP 3 BEFORE CHECK OUT)<\/font><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_28_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.4' type='checkbox'  value='REGISTRY'  id='choice_17_28_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_4' id='label_17_28_4' class='gform-field-label gform-field-label--type-inline'>REGISTRY<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_28_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.5' type='checkbox'  value='COASTWISE \u2013 BOWATERS ONLY (CERTIFICATE ON FILE)'  id='choice_17_28_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_5' id='label_17_28_5' class='gform-field-label gform-field-label--type-inline'>COASTWISE \u2013 BOWATERS ONLY (CERTIFICATE ON FILE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_28_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.6' type='checkbox'  value='COASTWISE \u2013 OIL SPILL RESPONSE ONLY (LETTER OF QUALIFICATION ON FILE)'  id='choice_17_28_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_6' id='label_17_28_6' class='gform-field-label gform-field-label--type-inline'>COASTWISE \u2013 OIL SPILL RESPONSE ONLY (LETTER OF QUALIFICATION ON FILE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_28_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.7' type='checkbox'  value='COASTWISE UNDER CHARTER TO AN ENTITY QUALIFIED TO ENGAGE IN COASTWISE TRADE (COPY OF CHARTER ON FILE)'  id='choice_17_28_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_28_7' id='label_17_28_7' class='gform-field-label gform-field-label--type-inline'>COASTWISE UNDER CHARTER TO AN ENTITY QUALIFIED TO ENGAGE IN COASTWISE TRADE (COPY OF CHARTER ON FILE)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_118\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_171\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >K. PRIMARY SERVICE &amp; HORSEPOWER: Select only ONE service for which the vessel will be primarily used and insert horsepower<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_17_171'>\n\t\t\t<div class='gchoice gchoice_17_171_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='COMMERCIAL FISHING BOAT'  id='choice_17_171_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_0' id='label_17_171_0' class='gform-field-label gform-field-label--type-inline'>COMMERCIAL FISHING BOAT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='FISH PROCESSING VESSEL'  id='choice_17_171_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_1' id='label_17_171_1' class='gform-field-label gform-field-label--type-inline'>FISH PROCESSING VESSEL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='FREIGHT SHIP'  id='choice_17_171_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_2' id='label_17_171_2' class='gform-field-label gform-field-label--type-inline'>FREIGHT SHIP<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='INDUSTRIAL VESSEL'  id='choice_17_171_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_3' id='label_17_171_3' class='gform-field-label gform-field-label--type-inline'>INDUSTRIAL VESSEL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='MOBILE OFFSHORE DRILLING UNIT'  id='choice_17_171_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_4' id='label_17_171_4' class='gform-field-label gform-field-label--type-inline'>MOBILE OFFSHORE DRILLING UNIT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='OIL RECOVERY'  id='choice_17_171_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_5' id='label_17_171_5' class='gform-field-label gform-field-label--type-inline'>OIL RECOVERY<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='OFFSHORE SUPPLY VESSEL'  id='choice_17_171_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_6' id='label_17_171_6' class='gform-field-label gform-field-label--type-inline'>OFFSHORE SUPPLY VESSEL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PASSENGER (6 OR FEWER)'  id='choice_17_171_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_7' id='label_17_171_7' class='gform-field-label gform-field-label--type-inline'>PASSENGER (6 OR FEWER)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PASSENGER (MORE THAN 6)'  id='choice_17_171_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_8' id='label_17_171_8' class='gform-field-label gform-field-label--type-inline'>PASSENGER (MORE THAN 6)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PASSENGER BARGE (6 OR FEWER)'  id='choice_17_171_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_9' id='label_17_171_9' class='gform-field-label gform-field-label--type-inline'>PASSENGER BARGE (6 OR FEWER)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PASSENGER BARGE (MORE THAN 6)'  id='choice_17_171_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_10' id='label_17_171_10' class='gform-field-label gform-field-label--type-inline'>PASSENGER BARGE (MORE THAN 6)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PUBLIC FREIGHT'  id='choice_17_171_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_11' id='label_17_171_11' class='gform-field-label gform-field-label--type-inline'>PUBLIC FREIGHT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PUBLIC TANKSHIP\/BARGE'  id='choice_17_171_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_12' id='label_17_171_12' class='gform-field-label gform-field-label--type-inline'>PUBLIC TANKSHIP\/BARGE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='PUBLIC VESSEL, UNC'  id='choice_17_171_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_13' id='label_17_171_13' class='gform-field-label gform-field-label--type-inline'>PUBLIC VESSEL, UNC<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='RECREATIONAL'  id='choice_17_171_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_14' id='label_17_171_14' class='gform-field-label gform-field-label--type-inline'>RECREATIONAL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='RESEARCH VESSEL'  id='choice_17_171_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_15' id='label_17_171_15' class='gform-field-label gform-field-label--type-inline'>RESEARCH VESSEL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='SCHOOL SHIP'  id='choice_17_171_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_16' id='label_17_171_16' class='gform-field-label gform-field-label--type-inline'>SCHOOL SHIP<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='TANK BARGE'  id='choice_17_171_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_17' id='label_17_171_17' class='gform-field-label gform-field-label--type-inline'>TANK BARGE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_18'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='TANK SHIP'  id='choice_17_171_18' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_18' id='label_17_171_18' class='gform-field-label gform-field-label--type-inline'>TANK SHIP<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_171_19'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_171' type='radio' value='TOWING VESSEL'  id='choice_17_171_19' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_171_19' id='label_17_171_19' class='gform-field-label gform-field-label--type-inline'>TOWING VESSEL<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_30\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_30'>HORSEPOWER<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_17_30' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_17_31' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_17_2_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_17_2' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_17_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_17_122\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>L. CITIZENSHIP OF OWNER (CHECK THE BOX(ES) TO SHOW THE TYPE(S) OF ENTITY(IES) THAT OWNS THE VESSEL)<\/strong><\/br>Vessel must be owned by a U.S. citizen eligible for the\nendorsement(s) sought. Select the section that describes the type of\nentity that owns the vessel. Citizenship for all owners must be\nprovided.<\/div><fieldset id=\"field_17_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >INDIVIDUAL: Includes native born and naturalized U.S. citizens.\n\nGOVERNMENT ENTITY: Includes Federal, State, Territory, Possession or Subdivision.\n\nCORPORATION: Complete all items that apply.\n\nLIMITED LIABILITY COMPANY (LLC):  Complete Equity Section and choose type. For member managed LLC, a list of members is required. Click icon for attachment if application covers multiple members.\n\nPARTNERSHIP: Complete Equity Section and choose type. A list of all general partners is required. Click icon for attachment if application covers multiple general partners.\n\nCORPORATIONS QUALIFIED UNDER 46 CFR 68.01 OR OWNED BY A NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE: Attach a copy of the Certificate of Compliance or Letter of Qualification issued by the Director, NVDC. \n\nJOINT VENTURE\/ASSOCIATION: A list of all joint venturers\/members is required. The percentage held by each need not be shown. Click icon for attachment if application covers multiple joint venturers\/members. \n\nTRUST ARRANGEMENT: All trustees must be U.S. citizens. If applicable, each beneficiary with an enforceable interest must be a citizen. A list of all trustees (except managing owner) and beneficiaries with an enforceable interest is required. Click icon for attachment if application covers multiple trustees\/beneficiaries with an enforceable interest.<\/legend><div class='gfield_description' id='gfield_description_17_40'><p><strong>INDIVIDUAL: <\/strong>Includes native born and naturalized U.S. citizens.<\/p>\n\n<p><strong>GOVERNMENT ENTITY: <\/strong>Includes Federal, State, Territory, Possession or Subdivision.<\/p>\n\n<p><strong>CORPORATION: <\/strong>Complete all items that apply.<\/p>\n\n<p><strong>LIMITED LIABILITY COMPANY (LLC):  <\/strong>Complete Equity Section and choose type. For member managed LLC, a list of members is required. Click icon for attachment if application covers multiple members.<\/p>\n\n<p><strong>PARTNERSHIP: <\/strong>Complete Equity Section and choose type. A list of all general partners is required. Click icon for attachment if application covers multiple general partners.<\/p>\n\n<p><strong>CORPORATIONS QUALIFIED UNDER 46 CFR 68.01 OR OWNED BY A NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE: <\/strong>Attach a copy of the Certificate of Compliance or Letter of Qualification issued by the Director, NVDC. <\/p>\n\n<p><strong>JOINT VENTURE\/ASSOCIATION: <\/strong>A list of all joint venturers\/members is required. The percentage held by each need not be shown. Click icon for attachment if application covers multiple joint venturers\/members. <\/p>\n\n<p><strong>TRUST ARRANGEMENT: <\/strong>All trustees must be U.S. citizens. If applicable, each beneficiary with an enforceable interest must be a citizen. A list of all trustees (except managing owner) and beneficiaries with an enforceable interest is required. Click icon for attachment if application covers multiple trustees\/beneficiaries with an enforceable interest.<\/p><\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_40'><div class='gchoice gchoice_17_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='ONE OR MORE INDIVIDUALS, I (WE) CERTIFY THAT ALL OWNERS OF THIS VESSEL ARE CITIZENS OF THE UNITED STATES'  id='choice_17_40_1'   aria-describedby=\"gfield_description_17_40\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_1' id='label_17_40_1' class='gform-field-label gform-field-label--type-inline'>ONE OR MORE INDIVIDUALS, I (WE) CERTIFY THAT ALL OWNERS OF THIS VESSEL ARE CITIZENS OF THE UNITED STATES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='GOVERNMENT ENTITY (FEDERAL, STATE, TERRITORY, POSSESSION OR SUBDIVISION)'  id='choice_17_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_2' id='label_17_40_2' class='gform-field-label gform-field-label--type-inline'>GOVERNMENT ENTITY (FEDERAL, STATE, TERRITORY, POSSESSION OR SUBDIVISION)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='CORPORATION (SEE SECTION M, ITEM 4 WHEN APPLYING FOR A FISHERY OR COASTWISE ENDORSEMENT).'  id='choice_17_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_3' id='label_17_40_3' class='gform-field-label gform-field-label--type-inline'>CORPORATION (SEE SECTION M, ITEM 4 WHEN APPLYING FOR A FISHERY OR COASTWISE ENDORSEMENT).<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='LIMITED LIABILITY COMPANY (LLC) (COMPLETE EQUITY SECTION AND CHOOSE TYPE)'  id='choice_17_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_4' id='label_17_40_4' class='gform-field-label gform-field-label--type-inline'>LIMITED LIABILITY COMPANY (LLC) (COMPLETE EQUITY SECTION AND CHOOSE TYPE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.5' type='checkbox'  value='PARTNERSHIP (COMPLETE EQUITY SECTION AND CHOOSE TYPE)'  id='choice_17_40_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_5' id='label_17_40_5' class='gform-field-label gform-field-label--type-inline'>PARTNERSHIP (COMPLETE EQUITY SECTION AND CHOOSE TYPE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.6' type='checkbox'  value='CORPORATION QUALIFIED AND APPLYING UNDER 46 CFR 68.01 (BOWATERS)'  id='choice_17_40_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_6' id='label_17_40_6' class='gform-field-label gform-field-label--type-inline'>CORPORATION QUALIFIED AND APPLYING UNDER 46 CFR 68.01 (BOWATERS)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.7' type='checkbox'  value='VESSEL OWNED OR OPERATED BY NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE'  id='choice_17_40_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_7' id='label_17_40_7' class='gform-field-label gform-field-label--type-inline'>VESSEL OWNED OR OPERATED BY NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.8' type='checkbox'  value='JOINT VENTURE OR ASSOCIATION'  id='choice_17_40_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_8' id='label_17_40_8' class='gform-field-label gform-field-label--type-inline'>JOINT VENTURE OR ASSOCIATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_40_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.9' type='checkbox'  value='TRUST ARRANGEMENT (COMPLETE EQUITY\/STOCK SECTION)'  id='choice_17_40_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_40_9' id='label_17_40_9' class='gform-field-label gform-field-label--type-inline'>TRUST ARRANGEMENT (COMPLETE EQUITY\/STOCK SECTION)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_69\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_69'>1. STATE OF INCORPORATION<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_17_69' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_70\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_70'>2 CITIZENSHIP OF CHIEF EXECUTIVE OFFICER BY WHATEVER TITLE<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_17_70' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_71\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_71'>3. CITIZENSHIP OF CHAIRMAN OF THE BOARD<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_17_71' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_72\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_72'>4. NUMBER OF DIRECTORS NECESSARY TO CONSTITUTE A QUORUM<\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_17_72' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_73\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_73'>5. NUMBER OF ALIEN DIRECTORS<\/label><div class='ginput_container ginput_container_text'><input name='input_73' id='input_17_73' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_131\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >6. PERCENTAGE OF STOCK OWNED BY U.S. CITIZENS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT, WITH THE ENDORSEMENT(S) SOUGHT ON THIS APPLICATION IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_131'><div class='gchoice gchoice_17_131_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_131.1' type='checkbox'  value='LESS THAN 50%'  id='choice_17_131_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_131_1' id='label_17_131_1' class='gform-field-label gform-field-label--type-inline'>LESS THAN 50%<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_131_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_131.2' type='checkbox'  value='50% OR MORE: (I)'  id='choice_17_131_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_131_2' id='label_17_131_2' class='gform-field-label gform-field-label--type-inline'>50% OR MORE: (I)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_131_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_131.3' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)'  id='choice_17_131_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_131_3' id='label_17_131_3' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_131_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_131.4' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)'  id='choice_17_131_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_131_4' id='label_17_131_4' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_132\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_132'>STATE EXACT PERCENTAGE<\/label><div class='ginput_container ginput_container_text'><input name='input_132' id='input_17_132' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_133\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >CORPORATION QUALIFIED AND APPLYING UNDER 46 CFR 68.01 (BOWATERS)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_133'><div class='gchoice gchoice_17_133_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.1' type='checkbox'  value='I (WE) CERTIFY THAT THE CORPORATE STRUCTURE HAS NOT CHANGED SINCE ISSUANCE OF THE CERTIFICATE OF COMPLIANCE.'  id='choice_17_133_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_133_1' id='label_17_133_1' class='gform-field-label gform-field-label--type-inline'>I (WE) CERTIFY THAT THE CORPORATE STRUCTURE HAS NOT CHANGED SINCE ISSUANCE OF THE CERTIFICATE OF COMPLIANCE.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_174\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >VESSEL OWNED OR OPERATED BY NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_174'><div class='gchoice gchoice_17_174_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_174.1' type='checkbox'  value='I (WE) CERTIFY THAT THE INFORMATION ON FILE WITH REGARD TO COOPERATIVE AND ISSUANCE OF THE LETTER OF QUALIFICATION REMAINS UNCHANGED.'  id='choice_17_174_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_174_1' id='label_17_174_1' class='gform-field-label gform-field-label--type-inline'>I (WE) CERTIFY THAT THE INFORMATION ON FILE WITH REGARD TO COOPERATIVE AND ISSUANCE OF THE LETTER OF QUALIFICATION REMAINS UNCHANGED.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_175\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >JOINT VENTURE OR ASSOCIATION<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_175'><div class='gchoice gchoice_17_175_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_175.1' type='checkbox'  value='I (WE) CERTIFY THAT ALL MEMBERS OF THIS (JOINT VENTURE) (ASSOCIATION) ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT(S) SOUGHT.'  id='choice_17_175_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_175_1' id='label_17_175_1' class='gform-field-label gform-field-label--type-inline'>I (WE) CERTIFY THAT ALL MEMBERS OF THIS (JOINT VENTURE) (ASSOCIATION) ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT(S) SOUGHT.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_134\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >LIMITED LIABILITY COMPANY (LLC): (COMPLETE EQUITY SECTION AND CHOOSE TYPE) (SEE SECTION M, ITEM 5 WHEN APPLYING FOR A FISHERY OR COASTWISE ENDORSEMENT).<\/legend><div class='gfield_description' id='gfield_description_17_134'><b>EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C).<\/b><\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_134'><div class='gchoice gchoice_17_134_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.1' type='checkbox'  value='LESS THAN 50%'  id='choice_17_134_1'   aria-describedby=\"gfield_description_17_134\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_17_134_1' id='label_17_134_1' class='gform-field-label gform-field-label--type-inline'>LESS THAN 50%<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_134_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.2' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)'  id='choice_17_134_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_134_2' id='label_17_134_2' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_134_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.3' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)'  id='choice_17_134_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_134_3' id='label_17_134_3' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_134_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.4' type='checkbox'  value='50% OR MORE: (I)'  id='choice_17_134_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_134_4' id='label_17_134_4' class='gform-field-label gform-field-label--type-inline'>50% OR MORE: (I)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_176\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_176'>List of All Joint Ventures\/Members (First &amp; Last Name(s)):<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_176' id='input_17_176' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_17_135\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_135'>STATE EXACT PERCENTAGE<\/label><div class='ginput_container ginput_container_text'><input name='input_135' id='input_17_135' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_136\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_136'><div class='gchoice gchoice_17_136_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_136.1' type='checkbox'  value='&lt;b&gt;1. MEMBER MANAGED LIMITED LIABILITY COMPANY I (WE) CERTIFY THAT ALL MEMBERS OF THIS LLC ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.&lt;\/b&gt;'  id='choice_17_136_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_136_1' id='label_17_136_1' class='gform-field-label gform-field-label--type-inline'><b>1. MEMBER MANAGED LIMITED LIABILITY COMPANY I (WE) CERTIFY THAT ALL MEMBERS OF THIS LLC ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.<\/b><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_177\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_177'>LIST OF ALL MEMBERS (FIRST &amp; LAST NAME(S)):<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_177' id='input_17_177' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_17_137\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >OR<\/div><fieldset id=\"field_17_138\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2. LIMITED LIABILITY COMPANY NOT MANAGED BY MEMBERS AND NOT SIMILAR TO GENERAL PARTNERSHIP: PLEASE NOTE (A) &amp; (B) MUST BE CHECKED FOR FISHERY AND COASTWISE ENDORSEMENTS; NOT REQUIRED FOR COASTWISE OIL SPILL OR COASTWISE UNDER CHARTER ENDORSEMENTS.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_138'><div class='gchoice gchoice_17_138_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_138.1' type='checkbox'  value='A. I (WE) CERTIFY THAT ANY PERSON ELECTED TO MANAGE THE LLC OR WHO IS AUTHORIZED TO BIND THE LLC, AND ANY PERSON WHO HOLDS A POSITION EQUIVALENT TO THE CHIEF EXECUTIVE OFFICER, BY WHATEVER TITLE, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS IN A CORPORATION, AND ANY PERSONS AUTHORIZED TO ACT IN THEIR ABSENCE ARE CITIZENS OF THE UNITED STATES'  id='choice_17_138_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_138_1' id='label_17_138_1' class='gform-field-label gform-field-label--type-inline'>A. I (WE) CERTIFY THAT ANY PERSON ELECTED TO MANAGE THE LLC OR WHO IS AUTHORIZED TO BIND THE LLC, AND ANY PERSON WHO HOLDS A POSITION EQUIVALENT TO THE CHIEF EXECUTIVE OFFICER, BY WHATEVER TITLE, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS IN A CORPORATION, AND ANY PERSONS AUTHORIZED TO ACT IN THEIR ABSENCE ARE CITIZENS OF THE UNITED STATES<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_138_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_138.2' type='checkbox'  value='B. NON-CITIZENS DO NOT HAVE AUTHORITY WITHIN A MANAGEMENT GROUP, WHETHER THROUGH VETO POWER, COMBINED VOTING, OR OTHERWISE, TO EXERCISE CONTROL OVER THE LLC'  id='choice_17_138_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_138_2' id='label_17_138_2' class='gform-field-label gform-field-label--type-inline'>B. NON-CITIZENS DO NOT HAVE AUTHORITY WITHIN A MANAGEMENT GROUP, WHETHER THROUGH VETO POWER, COMBINED VOTING, OR OTHERWISE, TO EXERCISE CONTROL OVER THE LLC<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_139\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_139'>STATE WHERE ORGANIZED<\/label><div class='ginput_container ginput_container_text'><input name='input_139' id='input_17_139' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_140\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >PARTNERSHIP (COMPLETE EQUITY SECTION AND CHOOSE TYPE) (SEE SECTION M, ITEM 5 WHEN APPLYING FOR FISHERY OR COASTWISE ENDORSEMENT) EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_140'><div class='gchoice gchoice_17_140_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.1' type='checkbox'  value='LESS THAN 50%'  id='choice_17_140_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_140_1' id='label_17_140_1' class='gform-field-label gform-field-label--type-inline'>LESS THAN 50%<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_140_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.2' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)'  id='choice_17_140_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_140_2' id='label_17_140_2' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_140_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.3' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)'  id='choice_17_140_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_140_3' id='label_17_140_3' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_140_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.4' type='checkbox'  value='50% OR MORE: (I)'  id='choice_17_140_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_140_4' id='label_17_140_4' class='gform-field-label gform-field-label--type-inline'>50% OR MORE: (I)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_141\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_141'>STATE EXACT PERCENTAGE<\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_17_141' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_142\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_142'><div class='gchoice gchoice_17_142_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.1' type='checkbox'  value='&lt;b&gt;1. GENERAL PARTNERSHIP&lt;\/b&gt;&lt;br&gt;I (WE) CERTIFY THAT ALL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.'  id='choice_17_142_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_142_1' id='label_17_142_1' class='gform-field-label gform-field-label--type-inline'><b>1. GENERAL PARTNERSHIP<\/b><br>I (WE) CERTIFY THAT ALL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_142_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.2' type='checkbox'  value='&lt;b&gt;2. LIMITED PARTNERSHIP&lt;\/b&gt;&lt;br&gt; I (WE) CERTIFY THAT ALL GENERAL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.'  id='choice_17_142_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_142_2' id='label_17_142_2' class='gform-field-label gform-field-label--type-inline'><b>2. LIMITED PARTNERSHIP<\/b><br> I (WE) CERTIFY THAT ALL GENERAL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_143\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_143'>LIST ALL GENERAL PARTNERS (REQUIRED)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_143' id='input_17_143' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_17_144\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >TRUST ARRANGEMENT<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_144'><div class='gchoice gchoice_17_144_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_144.1' type='checkbox'  value='I (WE) CERTIFY THAT ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST IN THIS TRUST ARRANGEMENT ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.'  id='choice_17_144_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_144_1' id='label_17_144_1' class='gform-field-label gform-field-label--type-inline'>I (WE) CERTIFY THAT ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST IN THIS TRUST ARRANGEMENT ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_145\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT(S) SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_145'><div class='gchoice gchoice_17_145_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.1' type='checkbox'  value='LESS THAN 50%'  id='choice_17_145_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_145_1' id='label_17_145_1' class='gform-field-label gform-field-label--type-inline'>LESS THAN 50%<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_145_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.2' type='checkbox'  value='50% OR MORE: (I)'  id='choice_17_145_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_145_2' id='label_17_145_2' class='gform-field-label gform-field-label--type-inline'>50% OR MORE: (I)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_145_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.3' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)'  id='choice_17_145_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_145_3' id='label_17_145_3' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_145_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_145.4' type='checkbox'  value='75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)'  id='choice_17_145_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_145_4' id='label_17_145_4' class='gform-field-label gform-field-label--type-inline'>75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_146\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_146'>STATE EXACT PERCENTAGE<\/label><div class='ginput_container ginput_container_text'><input name='input_146' id='input_17_146' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_147\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>OR<\/strong><\/div><fieldset id=\"field_17_148\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_148'><div class='gchoice gchoice_17_148_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.1' type='checkbox'  value='VESSEL OWNED IN A TRUST ARRANGEMENT PURSUANT TO 46 USC 12111(c) (CROSS BORDER FINANCING)'  id='choice_17_148_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_148_1' id='label_17_148_1' class='gform-field-label gform-field-label--type-inline'>VESSEL OWNED IN A TRUST ARRANGEMENT PURSUANT TO 46 USC 12111(c) (CROSS BORDER FINANCING)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_149\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_149'>LIST ALL ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST (REQUIRED)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_149' id='input_17_149' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_17_121\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_178\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label\">M. I (WE) CERTIFY THAT: (MARK ALL THAT ARE APPLICABLE. ITEM 5. NOT REQUIRED FOR COASTWISE BOWATER ONLY, OIL SPILL, OR UNDER CHARTER ENDORSEMENTS.)<\/label><br>\n\n<div class=\"gfield_description\">Complete as appropriate. The law provides severe penalties for false statements against both the person (including agents) making the statement and against the vessel for which it is made.<\/div><\/div><fieldset id=\"field_17_179\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox checkbox-spacing field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_179'><div class='gchoice gchoice_17_179_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_179.1' type='checkbox'  value='1. I AM (WE ARE) A CITIZEN(S) OF THE UNITED STATES AND LEGALLY AUTHORIZED TO EXECUTE THIS APPLICATION IN THE CAPACITY SHOWN;'  id='choice_17_179_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_179_1' id='label_17_179_1' class='gform-field-label gform-field-label--type-inline'>1. I AM (WE ARE) A CITIZEN(S) OF THE UNITED STATES AND LEGALLY AUTHORIZED TO EXECUTE THIS APPLICATION IN THE CAPACITY SHOWN;<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_180\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox checkbox-spacing field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_180'><div class='gchoice gchoice_17_180_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_180.1' type='checkbox'  value='2. IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART I) THE VESSEL(S) TO WHICH THIS APPLICATION APPLIES;'  id='choice_17_180_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_180_1' id='label_17_180_1' class='gform-field-label gform-field-label--type-inline'>2. IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART I) THE VESSEL(S) TO WHICH THIS APPLICATION APPLIES;<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_57\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' >(b) WILL AT ALL TIMES REMAIN UNDER THE COMMAND OF A U.S. CITIZEN, UNLESS DOCUMENTED SOLELY WITH A RECREATIONAL ENDORSEMENT; WILL NOT BE OPERATED IN A TRADE NOT AUTHORIZED BY THE ENDORSEMENT(S) ON THE CERTIFICATE(S) OF DOCUMENTATION. THE NAME(S) OF THE VESSEL(S) WILL NOT BE CHANGED WITHOUT APPROVAL FROM THE NATIONAL VESSEL DOCUMENTATION CENTER; AND I (WE) WILL PROMPTLY NOTIFY THE NATIONAL VESSEL DOCUMENTATION CENTER UPON A CHANGE IN ANY OF THE INFORMATION OR REPRESENTATIONS IN THIS APPLICATION.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_57'><div class='gchoice gchoice_17_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='(a) HAS (HAVE) BEEN MARKED'  id='choice_17_57_1'   aria-describedby=\"gfield_description_17_57\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_17_57_1' id='label_17_57_1' class='gform-field-label gform-field-label--type-inline'>(a) HAS (HAVE) BEEN MARKED<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_57_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.2' type='checkbox'  value='WILL BE MARKED;'  id='choice_17_57_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_57_2' id='label_17_57_2' class='gform-field-label gform-field-label--type-inline'>WILL BE MARKED;<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_17_57'>(b) WILL AT ALL TIMES REMAIN UNDER THE COMMAND OF A U.S. CITIZEN, UNLESS DOCUMENTED SOLELY WITH A RECREATIONAL ENDORSEMENT; WILL NOT BE OPERATED IN A TRADE NOT AUTHORIZED BY THE ENDORSEMENT(S) ON THE CERTIFICATE(S) OF DOCUMENTATION. THE NAME(S) OF THE VESSEL(S) WILL NOT BE CHANGED WITHOUT APPROVAL FROM THE NATIONAL VESSEL DOCUMENTATION CENTER; AND I (WE) WILL PROMPTLY NOTIFY THE NATIONAL VESSEL DOCUMENTATION CENTER UPON A CHANGE IN ANY OF THE INFORMATION OR REPRESENTATIONS IN THIS APPLICATION.<\/div><\/fieldset><fieldset id=\"field_17_181\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_inline checkbox-spacing field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_181'><div class='gchoice gchoice_17_181_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_181.1' type='checkbox'  value='3. HAS (HAVE) NOT   OR'  id='choice_17_181_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_181_1' id='label_17_181_1' class='gform-field-label gform-field-label--type-inline'>3. HAS (HAVE) NOT OR<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_181_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_181.2' type='checkbox'  value='3a. HAS (HAVE) BEEN REBUILT OR SUBSTANTIALLY ALTERED SINCE LAST DOCUMENTATION;'  id='choice_17_181_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_181_2' id='label_17_181_2' class='gform-field-label gform-field-label--type-inline'>3a. HAS (HAVE) BEEN REBUILT OR SUBSTANTIALLY ALTERED SINCE LAST DOCUMENTATION;<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_182\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox checkbox-spacing field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_182'><div class='gchoice gchoice_17_182_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_182.1' type='checkbox'  value='4. THE VESSEL IS (NOT TITLED UNDER A STATE OR TITLED UNDER THE LAWS OF [INPUT])'  id='choice_17_182_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_182_1' id='label_17_182_1' class='gform-field-label gform-field-label--type-inline'>4. THE VESSEL IS (NOT TITLED UNDER A STATE OR TITLED UNDER THE LAWS OF [INPUT])<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_17_58\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >THE VESSEL IS<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_58'><div class='gchoice gchoice_17_58_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.1' type='checkbox'  value='NOT TITLED UNDER A STATE (OR)'  id='choice_17_58_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_58_1' id='label_17_58_1' class='gform-field-label gform-field-label--type-inline'>NOT TITLED UNDER A STATE (OR)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_58_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.2' type='checkbox'  value='TITLED UNDER THE LAWS OF (INPUT BELOW)'  id='choice_17_58_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_58_2' id='label_17_58_2' class='gform-field-label gform-field-label--type-inline'>TITLED UNDER THE LAWS OF (INPUT BELOW)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_154\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_154'>TITLED UNDER THE LAWS OF:<\/label><div class='ginput_container ginput_container_text'><input name='input_154' id='input_17_154' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_17_60\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >THE FOLLOWING ITEM (5.) IS REQUIRED FOR COASTWISE AND\/OR FISHERY ENDORSEMENTS; HOWEVER, IT IS NOT REQUIRED FOR COASTWISE BOWATER ONLY, OIL SPILL, OR UNDER CHARTER ENDORSEMENTS.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_60'><div class='gchoice gchoice_17_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='5. U.S. CONTROL CERTIFICATION: THERE IS NO CONTRACT OR UNDERSTANDING THAT PROVIDES MORE THAN 25% OF THE VOTING POWER IN THE PARTNERSHIP, LIMITED LIABILITY COMPANY, CORPORATION, OR OTHER OWNING ENTITY EITHER DIRECTLY OR INDIRECTLY ON BEHALF OF ANY PERSON NOT A CITIZEN OF THE UNITED STATES. BY NO MEANS WHATSOEVER IS CONTROL IN EXCESS OF 25% CONFERRED UPON OR PERMITTED TO BE EXERCISED BY A PERSON WHO IS NOT A CITIZEN OF THE UNITED STATES.'  id='choice_17_60_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_60_1' id='label_17_60_1' class='gform-field-label gform-field-label--type-inline'>5. U.S. CONTROL CERTIFICATION: THERE IS NO CONTRACT OR UNDERSTANDING THAT PROVIDES MORE THAN 25% OF THE VOTING POWER IN THE PARTNERSHIP, LIMITED LIABILITY COMPANY, CORPORATION, OR OTHER OWNING ENTITY EITHER DIRECTLY OR INDIRECTLY ON BEHALF OF ANY PERSON NOT A CITIZEN OF THE UNITED STATES. BY NO MEANS WHATSOEVER IS CONTROL IN EXCESS OF 25% CONFERRED UPON OR PERMITTED TO BE EXERCISED BY A PERSON WHO IS NOT A CITIZEN OF THE UNITED STATES.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_183\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_61\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >POTENTIAL PENALTIES FOR FALSE STATEMENTS OR REPRESENTATIONS BY OWNER OR REPRESENTATIVE: CIVIL, MONETARY, VESSEL FORFEITURE (46 USC 12151), FINE AND\/OR IMPRISONMENT (18 USC 1001)<\/div><div id=\"field_17_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_62'>AUTHORIZED SIGNATURE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_17_62' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_62\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_62'>SIGNATURE (TYPE FULL NAME)<\/div><\/div><div id=\"field_17_198\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_198'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_17_198_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><input type='hidden' class='gform_hidden' name='input_17_198_valid' id='input_17_198_valid' \/><canvas id='input_17_198' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/usvesselregistrar.us\/nvdc\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_17_198_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_17_198_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_17_198_data' name='input_17_198_data' value=''><\/div><\/div><div id=\"field_17_63\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_63'>DATE<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_63' id='input_17_63' type='text' value='04\/12\/2026' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_17_63_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_17_63_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_17_63' class='gform_hidden' value='https:\/\/usvesselregistrar.us\/nvdc\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_17_64\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_17_64'>CAPACITY (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_17_64' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_64\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_64'>CAPACITY (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)<\/div><\/div><div id=\"field_17_65\" class=\"gfield gfield--type-html gfield--input-type-html application_fees_section gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >APPLICATION FEES ARE NOT REFUNDABLE (46 CFR 67.500 (e)).<\/div><div id=\"field_17_66\" class=\"gfield gfield--type-html gfield--input-type-html privacy_act_section gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >PRIVACY ACT STATEMENT IN ACCORDANCE WITH 5 U.S.C. 553a, 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 U.S.C., CHAPTERS 121 AND 125; 46 U.S.C. APP. 802 AND 883. 2. THE PRINCIPAL PURPOSES FOR WHICH THIS INFORMATION IS TO BE USED ARE: (1) TO DETERMINE CITIZENSHIP OF THE OWNER OF THE VESSEL FOR WHICH APPLICATION FOR DOCUMENTATION IS MADE; AND (2) TO DETERMINE ELIGIBILITY OF THE VESSEL TO BE DOCUMENTED WITH THE TRADE ENDORSEMENT SOUGHT. 3. THE ROUTINE USES WHICH MAY BE MADE OF THIS INFORMATION INCLUDE RELEASE TO LAW ENFORCEMENT OFFICIALS, TO THE GENERAL PUBLIC UNDER FREEDOM OF INFORMATION ACT, AND TO PUBLISH INFORMATION ABOUT U.S. DOCUMENTED VESSELS. 4. DISCLOSURE OF THE INFORMATION REQUESTED ON THIS FORM IS VOLUNTARY, HOWEVER, FAILURE TO PROVIDE THE INFORMATION REQUESTED WILL RESULT IN DENIAL OF THE APPLICATION FOR DOCUMENTATION, WHICH MAY PREVENT THE OWNER FROM OPERATING THE VESSEL(S) IN A SPECIFIED TRADE.<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_17_74' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_17_74' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_17_3_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_17_3' class='gform_page' data-js='page-field-id-74' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_17_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_17_189\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_127\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield_price gfield_price_17_126 gfield_option_17_126 field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please select any additional services you wish to add to have processed<\/legend><div class='gfield_description' id='gfield_description_17_127'><span style=\"color:red\">(IF YOU SELECTED FISHERY OR COASTWISE ON STEP 1 PLEASE CHECK THE APPROPRIATE BOXES BELOW)<\/span><\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_127'><div class='gchoice gchoice_17_127_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_127.1' type='checkbox'  value='Priority Request\/Rush Processing|75'  id='choice_17_127_1'   aria-describedby=\"gfield_description_17_127\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_17_127_1' id='label_17_127_1' class='gform-field-label gform-field-label--type-inline'>Priority Request\/Rush Processing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_127_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_127.2' type='checkbox'  value='Abstract of Title|75'  id='choice_17_127_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_127_2' id='label_17_127_2' class='gform-field-label gform-field-label--type-inline'>Abstract of Title<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_127_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_127.3' type='checkbox'  value='Certified Copy of COD|75'  id='choice_17_127_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_127_3' id='label_17_127_3' class='gform-field-label gform-field-label--type-inline'>Certified Copy of COD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_127_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_127.4' type='checkbox'  value='Preferred Mortgage|185'  id='choice_17_127_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_127_4' id='label_17_127_4' class='gform-field-label gform-field-label--type-inline'>Preferred Mortgage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_127_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_127.5' type='checkbox'  value='Satisfaction of Mortgage|145'  id='choice_17_127_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_127_5' id='label_17_127_5' class='gform-field-label gform-field-label--type-inline'>Satisfaction of Mortgage<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_194\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_195\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/div><div id=\"field_17_196\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_17_196 gfield_product_17_196 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_17_196_1'>Coastwise Endorsement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_196.1' value='Coastwise Endorsement' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_17_196' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_17_196' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_196.2' id='ginput_base_price_17_196' class='gform_hidden' value='$29.00' aria-label='Coastwise Endorsement Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_196.3' value='1' class='ginput_quantity_17_196 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_17_197\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_17_197 gfield_product_17_197 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_17_197_1'>Fishery Endorsement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_197.1' value='Fishery Endorsement' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_17_197' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_17_197' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_197.2' id='ginput_base_price_17_197' class='gform_hidden' value='$12.00' aria-label='Fishery Endorsement Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_197.3' value='1' class='ginput_quantity_17_197 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_17_207\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_206\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_17_206 gfield_product_17_206 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_17_206_1'>Lien\/Mortgage Processing Fee<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_206.1' value='Lien\/Mortgage Processing Fee' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_17_206' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_17_206' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_206.2' id='ginput_base_price_17_206' class='gform_hidden' value='$54.00' aria-label='Lien\/Mortgage Processing Fee Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_206.3' value='1' class='ginput_quantity_17_206 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_17_188\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_170\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>PRIORITY REQUEST REQUEST \/ RUSH PROCESSING<\/h3><\/div><div id=\"field_17_77\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_77'>Reason for Priority Request<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_17_77' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_17_129\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_129'><div class='gchoice gchoice_17_129_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_129.1' type='checkbox'  value='I (we) understand that making a false statement when applying for vessel documentation may subject the vessel to seizure by and forfeiture to the United States Government (46 USC \u00a712151, formerly 46 USC \u00a712122).' checked='checked' id='choice_17_129_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_129_1' id='label_17_129_1' class='gform-field-label gform-field-label--type-inline'>I (we) understand that making a false statement when applying for vessel documentation may subject the vessel to seizure by and forfeiture to the United States Government (46 USC \u00a712151, formerly 46 USC \u00a712122).<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_157\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_162\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>PREFERRED MORTGAGE<\/h3><\/div><fieldset id=\"field_17_163\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >INSTRUMENT TYPE (CHECK ALL THAT APPLY)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_163'><div class='gchoice gchoice_17_163_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.1' type='checkbox'  value='PREFERRED MORTGAGE'  id='choice_17_163_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_1' id='label_17_163_1' class='gform-field-label gform-field-label--type-inline'>PREFERRED MORTGAGE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.2' type='checkbox'  value='CHATTEL MORTGAGE'  id='choice_17_163_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_2' id='label_17_163_2' class='gform-field-label gform-field-label--type-inline'>CHATTEL MORTGAGE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.3' type='checkbox'  value='AMENDMENT'  id='choice_17_163_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_3' id='label_17_163_3' class='gform-field-label gform-field-label--type-inline'>AMENDMENT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.4' type='checkbox'  value='ASSUMPTION'  id='choice_17_163_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_4' id='label_17_163_4' class='gform-field-label gform-field-label--type-inline'>ASSUMPTION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.5' type='checkbox'  value='SUPPLEMENT'  id='choice_17_163_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_5' id='label_17_163_5' class='gform-field-label gform-field-label--type-inline'>SUPPLEMENT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.6' type='checkbox'  value='SUBORDINATION'  id='choice_17_163_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_6' id='label_17_163_6' class='gform-field-label gform-field-label--type-inline'>SUBORDINATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.7' type='checkbox'  value='ASSIGNMENT'  id='choice_17_163_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_7' id='label_17_163_7' class='gform-field-label gform-field-label--type-inline'>ASSIGNMENT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_163_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_163.8' type='checkbox'  value='OTHER (DESCRIBE)'  id='choice_17_163_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_163_8' id='label_17_163_8' class='gform-field-label gform-field-label--type-inline'>OTHER (DESCRIBE)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_164\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_164'>Describe<\/label><div class='ginput_container ginput_container_text'><input name='input_164' id='input_17_164' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_165\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_165'>NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_165' id='input_17_165' class='textarea medium'  aria-describedby=\"gfield_description_17_165\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_17_165'>GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES. <\/div><\/div><div id=\"field_17_166\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_166'>INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)<\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_17_166' type='text' value='' class='medium'    placeholder='IF 100%, PLEASE LEAVE BLANK'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_167\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_167'>NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_167' id='input_17_167' class='textarea medium'  aria-describedby=\"gfield_description_17_167\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_17_167'>GRANTEE. FOR PURPOSES OF THIS FORM, GRANTEES\nINCLUDE MORTGAGEES, ASSIGNEES, PERSON FROM WHOM MORTGAGES ARE ASSUMED, AND PERSON TO WHOM SUBORDINATION OF MORTGAGES ARE GRANTED. LIST ALL GRANTEES AND ADDRESSES.<\/div><\/div><div id=\"field_17_168\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_168'>INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)<\/label><div class='ginput_container ginput_container_text'><input name='input_168' id='input_17_168' type='text' value='' class='medium'    placeholder='IF 100%, PLEASE LEAVE BLANK'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_169\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_169'>Amount<\/label><div class='ginput_container ginput_container_text'><input name='input_169' id='input_17_169' type='text' value='' class='medium'    placeholder='$'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_161\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_158\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>SATISFACTION OF MORTGAGE<\/h3><\/div><fieldset id=\"field_17_78\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >INSTRUMENT TYPE (CHECK ALL THAT APPLY)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_78'><div class='gchoice gchoice_17_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='PREFERRED MORTGAGE'  id='choice_17_78_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_1' id='label_17_78_1' class='gform-field-label gform-field-label--type-inline'>PREFERRED MORTGAGE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.2' type='checkbox'  value='CHATTEL MORTGAGE'  id='choice_17_78_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_2' id='label_17_78_2' class='gform-field-label gform-field-label--type-inline'>CHATTEL MORTGAGE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.3' type='checkbox'  value='AMENDMENT'  id='choice_17_78_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_3' id='label_17_78_3' class='gform-field-label gform-field-label--type-inline'>AMENDMENT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.4' type='checkbox'  value='ASSUMPTION'  id='choice_17_78_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_4' id='label_17_78_4' class='gform-field-label gform-field-label--type-inline'>ASSUMPTION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.5' type='checkbox'  value='SUPPLEMENT'  id='choice_17_78_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_5' id='label_17_78_5' class='gform-field-label gform-field-label--type-inline'>SUPPLEMENT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.6' type='checkbox'  value='SUBORDINATION'  id='choice_17_78_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_6' id='label_17_78_6' class='gform-field-label gform-field-label--type-inline'>SUBORDINATION<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.7' type='checkbox'  value='ASSIGNMENT'  id='choice_17_78_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_7' id='label_17_78_7' class='gform-field-label gform-field-label--type-inline'>ASSIGNMENT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_78_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.8' type='checkbox'  value='OTHER (DESCRIBE)'  id='choice_17_78_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_78_8' id='label_17_78_8' class='gform-field-label gform-field-label--type-inline'>OTHER (DESCRIBE)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_159\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_159'>Describe<\/label><div class='ginput_container ginput_container_text'><input name='input_159' id='input_17_159' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_160\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_160'>NAME(S) AND ADDRESS(ES) OF GRANTOR(S) (MORTGAGOR(S), ASSIGNOR(S), ASSUMING PARTY(IES), OR OTHER(S)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_160' id='input_17_160' class='textarea medium'  aria-describedby=\"gfield_description_17_160\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_17_160'>GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES. <\/div><\/div><div id=\"field_17_80\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_80'>INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)<\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_17_80' type='text' value='' class='medium'    placeholder='IF 100%, PLEASE LEAVE BLANK'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_79\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_79'>NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_79' id='input_17_79' class='textarea medium'  aria-describedby=\"gfield_description_17_79\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_17_79'>GRANTEE. FOR PURPOSES OF THIS FORM, GRANTEES\nINCLUDE MORTGAGEES, ASSIGNEES, PERSON FROM WHOM MORTGAGES ARE ASSUMED, AND PERSON TO WHOM SUBORDINATION OF MORTGAGES ARE GRANTED. LIST ALL GRANTEES AND ADDRESSES.<\/div><\/div><div id=\"field_17_81\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_81'>INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)<\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_17_81' type='text' value='' class='medium'    placeholder='IF 100%, PLEASE LEAVE BLANK'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_82\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_82'>Amount<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_17_82' type='text' value='' class='medium'  aria-describedby=\"gfield_description_17_82\"  placeholder='$'  aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_17_82'>IF THE FOLLOWING INFORMATION IS UNKNOWN YOU MUST ORDER AN ABSTRACT OF TITLE UNDER ADDITIONAL SERVICES TOWARDS THE TOP OF THE PAGE.<\/div><\/div><div id=\"field_17_83\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_83'>RECORDED BOOK:<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_17_83' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_84\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_84'>Page<\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_17_84' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_125\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_125'>FILE\/RECORDED DATE:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_125' id='input_17_125' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_17_125_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_17_125_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_17_125' class='gform_hidden' value='https:\/\/usvesselregistrar.us\/nvdc\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_17_86\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_86'>TIME:<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_17_86' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_87\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_87'>OTHER IDENTIFYING DATA:<\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_17_87' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_173\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_209\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full vessel-type gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vessel Type?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_17_209'>\n\t\t\t<div class='gchoice gchoice_17_209_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_209' type='radio' value='Recreational'  id='choice_17_209_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_209_0' id='label_17_209_0' class='gform-field-label gform-field-label--type-inline'>Recreational<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_17_209_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_209' type='radio' value='Commercial'  id='choice_17_209_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_17_209_1' id='label_17_209_1' class='gform-field-label gform-field-label--type-inline'>Commercial<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_186\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_187\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox hide_addon_price vessel-renewal gfield_price gfield_price_17_126 gfield_option_17_126 field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >USCG RENEWAL DOCUMENTATION ADVANCED PAYMENT OPTION<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_187'><div class='gchoice gchoice_17_187_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_187.1' type='checkbox'  value='1 year renewal (additional $75.00)|75'  id='choice_17_187_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_187_1' id='label_17_187_1' class='gform-field-label gform-field-label--type-inline'>1 year renewal (additional $75.00)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_187_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_187.2' type='checkbox'  value='2 year renewal (additional $150.00)|150'  id='choice_17_187_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_187_2' id='label_17_187_2' class='gform-field-label gform-field-label--type-inline'>2 year renewal (additional $150.00)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_187_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_187.3' type='checkbox'  value='3 year renewal (additional $225.00)|225'  id='choice_17_187_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_187_3' id='label_17_187_3' class='gform-field-label gform-field-label--type-inline'>3 year renewal (additional $225.00)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_187_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_187.4' type='checkbox'  value='4 year renewal (additional $300.00)|300'  id='choice_17_187_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_187_4' id='label_17_187_4' class='gform-field-label gform-field-label--type-inline'>4 year renewal (additional $300.00)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_17_187_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_187.5' type='checkbox'  value='5 year renewal (additional $375.00)|375'  id='choice_17_187_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_187_5' id='label_17_187_5' class='gform-field-label gform-field-label--type-inline'>5 year renewal (additional $375.00)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_208\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >The NVDC issues a Certificate of Documentation (COD) for commercial vessels with a one-year validity period. If you purchase the Multi-Year Renewal option, you will receive a new certificate each year during your expiration month, for the number of years purchased, sent to the address on file. A single certificate covering the entire renewal period will not be provided.<br><\/div><div id=\"field_17_218\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_126\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_17_126 gfield_product_17_126 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_17_126_1'>VESSEL NAME OR HAILING PORT CHANGE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_126.1' value='VESSEL NAME OR HAILING PORT CHANGE' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_17_126' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_17_126' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_126.2' id='ginput_base_price_17_126' class='gform_hidden' value='$295.00' aria-label='VESSEL NAME OR HAILING PORT CHANGE Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_126.3' value='1' class='ginput_quantity_17_126 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_17_219\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_17_219 gfield_product_17_219 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_17_219_1'>Test Product<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_219.1' value='Test Product' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_17_219' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_17_219' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_219.2' id='ginput_base_price_17_219' class='gform_hidden' value='$0.51' aria-label='Test Product Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_219.3' value='1' class='ginput_quantity_17_219 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_17_102\" class=\"gfield gfield--type-total gfield--input-type-total gfield_price gfield_price_17_ gfield_total gfield_total_17_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_17_102'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_102' id='input_17_102' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_17' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_17_89\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Authorization<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_89'><div class='gchoice gchoice_17_89_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_89.1' type='checkbox'  value='[payment-authorization-message]' checked='checked' id='choice_17_89_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_89_1' id='label_17_89_1' class='gform-field-label gform-field-label--type-inline'>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. I understand that application and processing fees are non-refundable as per 46 CFR 67.500(e). By clicking the submit button you are agreeing to our terms and conditions. I understand that submitting another application for vessel documentation will supersede the current\/pending application for that vessel.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_172\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_17_217' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_17_217' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_17_4_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_17_4' class='gform_page' data-js='page-field-id-217' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_17_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_17_216\" class=\"gfield gfield--type-stripe_creditcard gfield--input-type-stripe_creditcard gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--type-stripe_creditcard-card\"  ><label class='gfield_label gfield_label_before_complex gform-field-label' for='input_17_216_1'>Credit Card<\/label><div class='ginput_complex ginput_container ginput_container_creditcard ginput_stripe_creditcard gform-grid-row' id='input_17_216'><div class='ginput_full gform-grid-col' id='input_17_216_1_container' data-payment-element='false'><div id='input_17_216_1' class='gform-theme-field-control StripeElement--card'><\/div><label for='input_17_216_1' id='input_17_216_1_label' class='gform-field-label gform-field-label--type-sub'>Card Details<\/label><\/div><!-- .ginput_full --><div class='ginput_full gform-grid-col' id='input_17_216_5_container'>\r\n\t\t\t\t\t<input type='text' name='input_216.5' id='input_17_216_5' value=''>\r\n\t\t\t\t\t<label for='input_17_216_5' id='input_17_216_5_label' class='gform-field-label gform-field-label--type-sub'>Cardholder Name<\/label>\r\n\t\t\t\t<\/div><\/div><!-- .ginput_container -->\r\n\t\t\t<style type=\"text\/css\">\r\n\t\t\t\t:root {\r\n  \t\t\t\t\t--link-login-string: \"Link login\"\r\n\t\t\t\t}\r\n\t\t\t<\/style><\/div><div id=\"field_17_185\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_96\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Having Trouble? Check this box to move forward without your Credit Card<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_17_96'><div class='gchoice gchoice_17_96_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_96.1' type='checkbox'  value='*My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment'  id='choice_17_96_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_17_96_1' id='label_17_96_1' class='gform-field-label gform-field-label--type-inline'>*My card information is not working; I would like to continue my submission and receive a call from a specialist regarding payment<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_17_97\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_98\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >BILLING ADDRESS<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_17_98' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_17_98_1_container' >\n                                        <input type='text' name='input_98.1' id='input_17_98_1' value=''    aria-required='true'    \/>\n                                        <label for='input_17_98_1' id='input_17_98_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_17_98_2_container' >\n                                        <input type='text' name='input_98.2' id='input_17_98_2' value=''     aria-required='false'   \/>\n                                        <label for='input_17_98_2' id='input_17_98_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_17_98_3_container' >\n                                    <input type='text' name='input_98.3' id='input_17_98_3' value=''    aria-required='true'    \/>\n                                    <label for='input_17_98_3' id='input_17_98_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_17_98_4_container' >\n                                        <input type='text' name='input_98.4' id='input_17_98_4' value=''      aria-required='true'    \/>\n                                        <label for='input_17_98_4' id='input_17_98_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_17_98_5_container' >\n                                    <input type='text' name='input_98.5' id='input_17_98_5' value=''    aria-required='true'    \/>\n                                    <label for='input_17_98_5' id='input_17_98_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_17_98_6_container' >\n                                        <select name='input_98.6' id='input_17_98_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_17_98_6' id='input_17_98_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_17_184\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_17_99\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_17_99_container'>\n                                <span id='input_17_99_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_99' id='input_17_99' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_17_99' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_17_99_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_99_2' id='input_17_99_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_17_99_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_17_100\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_100'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_100' id='input_17_100' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_17_100\"  \/><\/div><div class='gfield_description' id='gfield_description_17_100'>(###) ###-####<\/div><\/div><fieldset id=\"field_17_214\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full overflow-tc gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to Terms and Conditions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_214.1' id='input_17_214_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_17_214\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_17_214_1' >I agree to the terms and conditions below:<\/label><input type='hidden' name='input_214.2' value='I agree to the terms and conditions below:' class='gform_hidden' \/><input type='hidden' name='input_214.3' value='43' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_17_214' tabindex='0'>By clicking submit you agree to these <a target=\"_blank\" href=\"https:\/\/usvesselregistrar.us\/terms-and-conditions\/\">Terms and Conditions<\/a> and the above authorization of payment.<\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_17' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <button type='button'  id='gform_save_17_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_17' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_17' id='gform_theme_17' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_17' id='gform_style_settings_17' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_17' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='17' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_17' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_17' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_17' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_17' id='gform_target_page_number_17' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_17' id='gform_source_page_number_17' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 17, 'https:\/\/usvesselregistrar.us\/nvdc\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_17').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_17');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_17').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_17').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_17').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_17').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_17').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_17').val();gformInitSpinner( 17, 'https:\/\/usvesselregistrar.us\/nvdc\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [17, current_page]);window['gf_submitting_17'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_17').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_17').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [17]);window['gf_submitting_17'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_17').text());}else{jQuery('#gform_17').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"17\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_17\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_17\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_17\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 17, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-583","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Online Change on Name of USCG Vessel and Hailing Port<\/title>\n<meta name=\"description\" content=\"Change the name of USCG vessel and hailing port online here. This form is secure, protected by SSL encryption, so your personal information is safe.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Online Change on Name of USCG Vessel and Hailing Port\" \/>\n<meta property=\"og:description\" content=\"Change the name of USCG vessel and hailing port online here. This form is secure, protected by SSL encryption, so your personal information is safe.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/\" \/>\n<meta property=\"og:site_name\" content=\"Vessel Registrar LLC\" \/>\n<meta property=\"article:modified_time\" content=\"2023-11-06T01:40:25+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/\",\"url\":\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/\",\"name\":\"Online Change on Name of USCG Vessel and Hailing Port\",\"isPartOf\":{\"@id\":\"https:\/\/usvesselregistrar.us\/nvdc\/#website\"},\"datePublished\":\"2016-08-09T16:43:22+00:00\",\"dateModified\":\"2023-11-06T01:40:25+00:00\",\"description\":\"Change the name of USCG vessel and hailing port online here. This form is secure, protected by SSL encryption, so your personal information is safe.\",\"breadcrumb\":{\"@id\":\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/usvesselregistrar.us\/nvdc\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CHANGE OF VESSEL NAME OR HAILING PORT\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/usvesselregistrar.us\/nvdc\/#website\",\"url\":\"https:\/\/usvesselregistrar.us\/nvdc\/\",\"name\":\"Vessel Registrar LLC\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/usvesselregistrar.us\/nvdc\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Online Change on Name of USCG Vessel and Hailing Port","description":"Change the name of USCG vessel and hailing port online here. This form is secure, protected by SSL encryption, so your personal information is safe.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/","og_locale":"en_US","og_type":"article","og_title":"Online Change on Name of USCG Vessel and Hailing Port","og_description":"Change the name of USCG vessel and hailing port online here. This form is secure, protected by SSL encryption, so your personal information is safe.","og_url":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/","og_site_name":"Vessel Registrar LLC","article_modified_time":"2023-11-06T01:40:25+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/","url":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/","name":"Online Change on Name of USCG Vessel and Hailing Port","isPartOf":{"@id":"https:\/\/usvesselregistrar.us\/nvdc\/#website"},"datePublished":"2016-08-09T16:43:22+00:00","dateModified":"2023-11-06T01:40:25+00:00","description":"Change the name of USCG vessel and hailing port online here. This form is secure, protected by SSL encryption, so your personal information is safe.","breadcrumb":{"@id":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/usvesselregistrar.us\/nvdc\/change-vessel-name-hailing-port\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/usvesselregistrar.us\/nvdc\/"},{"@type":"ListItem","position":2,"name":"CHANGE OF VESSEL NAME OR HAILING PORT"}]},{"@type":"WebSite","@id":"https:\/\/usvesselregistrar.us\/nvdc\/#website","url":"https:\/\/usvesselregistrar.us\/nvdc\/","name":"Vessel Registrar LLC","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/usvesselregistrar.us\/nvdc\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/pages\/583","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/comments?post=583"}],"version-history":[{"count":2,"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/pages\/583\/revisions"}],"predecessor-version":[{"id":613,"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/pages\/583\/revisions\/613"}],"wp:attachment":[{"href":"https:\/\/usvesselregistrar.us\/nvdc\/wp-json\/wp\/v2\/media?parent=583"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}