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DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD OMB 16250040 Small Vessel Sea Service Form CG 719S (REV 03/04) Expires 07/31/2009 PAGE 1 Section I Applicant Information (Note: Complete One Form per

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cg 719 spdf via is a form used by the United States Coast Guard for documenting a physical examination for maritime personnel.

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