CERTIFICATION

The undersigned,____________________________________

(Name of Applicant State)

(Mailing Address)

hereby applies for the transfer of ship(s) pursuant to the provisions of Public Law 92-402, (16 U.S.C. 1220 et seq) as amended by H.R. 4546 Section 3504(a), for sinking and use of the ship(s) solely as an offshore artificial reef(s) for the conservation of marine life. Said State gives it assurance to the Secretary of Transportation that the transferred ship(s) will be properly chartered when sunk; and agrees to comply with the terms and conditions as stated in fulfillment of the provisions of Public Law 92-402 as amended. Said state further agrees to accept the ship(s) allocated in an "as is – where is" condition at no cost to the Federal Government except for any financial assistance provided under Section 7, and to remove said vessel(s) at a mutually agreed upon date to be determined.

EXECUTION

IN WITNESS WHEREOF this application has been duly executed at

________________________this_______day of _________, 200_

(Name of State)

By______________________________

(Signature and Title of Authorized State Official