PAGE 1 OF ____

UNITED STATES OF AMERICA

U.S. DEPARTMENT OF HOMELAND SECURITY

UNITED STATES COAST GUARD

NAME AND ADDRESS OF ATTORNEY OR RESPONDENT WITHOUT ATTORNEY:

ATTORNEY FOR (NAME):

FOR DOCKETING CENTER USE ONLY

COMPLAINANT:

United States Coast Guard

RESPONDENT: DOCKET NUMBER

ANSWER COAST GUARD ENFORCEMENT ACTIVITY NUMBER

This Answer is filed in response to a Complaint issued by Coast Guard ___________________________ on ________________.

1. Respondent ADMITS all jurisdictional allegations.

Respondent DENIES the following numbered paragraphs in the jurisdictional allegations and admits all others:

(NOTE: If Respondent states they lack sufficient knowledge or information to admit or deny a particular paragraph, the allegation is DENIED.)

2. Respondent ADMITS all factual allegations.

Respondent DENIES the following numbered paragraphs in the factual allegations and admits all others:

(NOTE: If Respondent states they lack sufficient knowledge or information to admit or deny a particular paragraph, the allegation is DENIED.)

3. Respondent affirmatively alleges as a defense:

Expiration of time limitation for service of complaint (46 CFR 5.55). Other. (Specify)

4. Respondent agrees with the proposed order. Respondent wishes to be heard on the proposed order.

5. Respondent agrees with the proposed hearing location and dates. Respondent proposes the following: 

Hearing Location:___________________________________ Dates:

First Choice Second Choice Third Choice Fourth Choice

6. Respondent requests settlement discussions: Yes No

Done at ____________________________, ________ this ______ day of ______________________, 19_____ or 20_____.

____________________________________________________ ________________________________________________
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Type or print name Signature of Respondent or representative

CERTIFICATE OF SERVICE

 I hereby certify that I have filed the foregoing document[s] with the Administrative Law Judge (ALJ) Docketing Center by: 

 Mail  Express Courier Service  Fax  In Person

 I hereby certify that I have filed the foregoing document[s] with the U.S. Coast Guard Unit shown on Page 1 of the Complaint 

by:  Mail  Express Courier Service  Fax  In Person

______________________________ ___________________________________________________ ___________________ Type or print name Signature Date

ORIGINAL—ALJ Docketing Center

CG-2639A (Rev. 2-99)

UNITED STATES OF AMERICA

U.S. DEPARTMENT OF HOMELAND SECURITY

UNITED STATES COAST GUARD

NAME AND ADDRESS OF ATTORNEY OR RESPONDENT WITHOUT ATTORNEY:

ATTORNEY FOR (NAME):

FOR DOCKETING CENTER USE ONLY

COMPLAINANT:

United States Coast Guard

RESPONDENT: DOCKET NUMBER

ANSWER COAST GUARD ENFORCEMENT ACTIVIITY NUMBER

This Answer is filed in response to a Complaint issued by Coast Guard ___________________________ on _________________.

1. Respondent ADMITS all jurisdictional allegations.

Respondent DENIES the following numbered paragraphs in the jurisdictional allegations and admits all others:

(NOTE: If Respondent states they lack sufficient knowledge or information to admit or deny a particular paragraph, the allegation is DENIED.)

2. Respondent ADMITS all factual allegations.

Respondent DENIES the following numbered paragraphs in the factual allegations and admits all others:

(NOTE: If Respondent states they lack sufficient knowledge or information to admit or deny a particular paragraph, the allegation is DENIED.)

3. Respondent affirmatively alleges as a defense:

Expiration of time limitation for service of complaint (46 CFR 5.55). Other. (Specify)

4. Respondent agrees with the proposed order. Respondent wishes to be heard on the proposed order.

5. Respondent agrees with the proposed hearing location and dates. Respondent proposes the following: 

Hearing Location:___________________________________ Dates:

First Choice Second Choice Third Choice Fourth Choice

6. Respondent requests settlement discussions: Yes No

Done at ____________________________, ________ this ______ day of ______________________, 19_____ or 20_____.
 PAGE 1 OF ____

____________________________________________________ ________________________________________________

Type or print name Signature of Respondent or representative

CERTIFICATE OF SERVICE

 I hereby certify that I have filed the foregoing document[s] with the Administrative Law Judge (ALJ) Docketing Center by: 

 Mail  Express Courier Service  Fax  In Person

 I hereby certify that I have filed the foregoing document[s] with the U.S. Coast Guard Unit shown on Page 1 of the Complaint 

by:  Mail  Express Courier Service  Fax  In Person

______________________________ ___________________________________________________ ___________________ Type or print name Signature Date

COPY— Coast Guard 

CG-2639A (Rev. 2-99)

UNITED STATES OF AMERICA

U.S. DEPARTMENT OF HOMELAND SECURITY

UNITED STATES COAST GUARD

NAME AND ADDRESS OF ATTORNEY OR RESPONDENT WITHOUT ATTORNEY:

ATTORNEY FOR (NAME):

FOR DOCKETING CENTER USE ONLY

COMPLAINANT:

United States Coast Guard

RESPONDENT: DOCKET NUMBER

ANSWER COAST GUARD ENFORCEMENT ACTIVITY NUMBER

This Answer is filed in response to a Complaint issued by Coast Guard ___________________________ on _________________.

1. Respondent ADMITS all jurisdictional allegations.

Respondent DENIES the following numbered paragraphs in the jurisdictional allegations and admits all others:

(NOTE: If Respondent states they lack sufficient knowledge or information to admit or deny a particular paragraph, the allegation is DENIED.)

2. Respondent ADMITS all factual allegations.

Respondent DENIES the following numbered paragraphs in the factual allegations and admits all others:

(NOTE: If Respondent states they lack sufficient knowledge or information to admit or deny a particular paragraph, the allegation is DENIED.)

3. Respondent affirmatively alleges as a defense:

Expiration of time limitation for service of complaint (46 CFR 5.55). Other. (Specify)

4. Respondent agrees with the proposed order. Respondent wishes to be heard on the proposed order.

5. Respondent agrees with the proposed hearing location and dates. Respondent proposes the following: 

Hearing Location:___________________________________ Dates:

First Choice Second Choice Third Choice Fourth Choice

6. Respondent requests settlement discussions: Yes No
 PAGE 1 OF ____

Done at ____________________________, ________ this ______ day of ______________________, 19_____ or 20_____.

____________________________________________________ ________________________________________________

Type or print name Signature of Respondent or representative

CERTIFICATE OF SERVICE

 I hereby certify that I have filed the foregoing document[s] with the Administrative Law Judge (ALJ) Docketing Center by: 

 Mail  Express Courier Service  Fax  In Person

 I hereby certify that I have filed the foregoing document[s] with the U.S. Coast Guard Unit shown on Page 1 of the Complaint 

by:  Mail  Express Courier Service  Fax  In Person

______________________________ ___________________________________________________ ___________________ Type or print name Signature Date

COPY—Respondent

CG-2639A (Rev. 2-99)