THIS SECTION FOR RECORDERS USE ONLY

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD NOTICE OF CLAIM
46 CFR OF MARITIME LIEN
67.250
REGISTERED MAIL NUMBER
1. NAME OF VESSEL 2. UNIQUE IDENTIFIER
U. S. M/V LIBELEES ALL BIRTH CERTIFICATE NUMER, SS#,
CAP NAME BAR CARD #, EIN#, ETC.
RECORDED
3. INSTRUMENT TYPE:
AFFIDAVIT OF SPECIFIC NEGATIVE AVERMENT, PORT

OPPORTUNITY TO CURE, AND COUNTERCLAIM BOOK

BY
4. NAME AND ADDRESS OF OWNER OF VESSEL

RAY LAHOOD
US Transportation
1200 New Jersey Ave., SE
Washington, DC 20590
INTEREST OWNED IN VESSEL AFFECTED BY ATTACHED INSTRUMENTS 100%. (100% UNLESS OTHERWISE STATED)
_______________________________

5. NAME AND ADDRESS OF CLAIMANT

UPPER LOWER CASED NAME OF CLAIMANT

PERCENTAGE OF VESSEL MORTGAGED OR MORTGAGE ASSIGNED 100%. (100% UNLESS OTHERWISE STATED)
_

6. AMOUNT 7. ALL PROPERTY INCLUDING BUT NOT LIMITED TO: ALL BANK ACCOUNTS, SAFETY
DEPOSIT BOXES, CERTIFICATES OF DEPOSIT (CD), RETIREMENT FUNDS, 801K'S, 401K'S,
REAL ESTATE, STOCKS, BONDS OF ANY TYPE, SECURITIES, CASH ON HAND, JEWELRY,
HOUSES, LANDS, MOTOR VEHICLES, AUTOMOBILES, MOTORHOMES, AIRCRAFT,
AMOUNT OF DAMAGES WATERCRAFT, HOUSEHOLD FURNITURE, GUNS, AMMUNITION, COIN COLLECTIONS, ALL
FROM COUNTERCLAIM, COLLECTIBLES ITEMS, INSURANCE POLICIES, CREDIT CARDS, LINES OF CREDIT, ALL
REVENUE STREAMS AND SOURCES OF INCOME FROM ANY SOURCE, FARM
PLUS INTEREST, EQUIPMENT, FARM SUPPLIES, HEAVY EQUIPMENT, CROPS, FARM ANIMALS,
MACHINERY, TOOLS, BUILDINGS, STRUCTURES, OFFICE EQUIPMENT AND SUPPLIES,
PENALTIES, AND FEES ALL CORPORATE ASSETS, WATER RIGHTS, MINERAL RIGHTS, INTELLECTUAL
PROPERTIES, PATENTS, INVENTIONS, OR ANY OTHER THING OF VALUE AS NEEDED TO
SATISFY THIS CLAIM. DEBTOR IS A TRUST. DEBTOR IS A TRANSMITTING UTILITY.
8. CERTIFICATION AND ATTESTATION:

I (WE) HEREBY CERTIFY THAT THE FACTS RECITED HEREIN ARE TRUE AND CORRECT. I (WE)
UNDERSTAND THAT THE U.S. COAST GUARD WILL RELY ON THOSE RECITATIONS IN INDEXING THE
ATTACHED INSTRUMENTS. THE OWNER AND ALL RECORDED MARITIME LIENHOLDERS HAVE BEEN NOTIFIED
BY U.S. MAIL _____________________________________________________ .
____________________________________________________ , Claimant
________________________________________________________________________________________________________________

STATE: PENNSYLVANIA SIGNATURE OF CLAIMANT

COUNTY: ALLEGHENY
SUBSCRIBED AND SWORN ON THE _______ day of December, AD 2007:

_________________________________________________________________________________________________

NOTARY PUBLIC
MY COMMISSION EXPIRES:______________________________________________________________
(DATE)