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I am making this statement in order that I the applicant may obtain a license/document to operate a vessel under the provisions of Title 46 CFR as applicable. I understand that if I make any false or fraudulent statement in this certification of service I may be subject to a fine or imprisonment of up to five 5 years or both 18 U. S. C. 1001. X Signature of Applicant NOTE Date If you were not the owner the Owner Operator or Master must complete the remainder of this form. If you were the owner ...

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