DO NOT MARK IN THIS SPACE--OFFICE USE ONLY    DL#                     

PLEASE COMPLETE ENTIRE FORM BELOW:

STATE OF PRINCIPAL USE:            DELAWARE                                    

HULL:                                                          PROPULSION:

          1.  (  )  WOOD                                                 1.  (  )  OUTBOARD

          2.  (  )  METAL                                                 2.  (  )  INBOARD

          3.  (  )  INFLATABLE                                      3.  (  )  IN/OB

          4.  (  )  FIBERGLASS                                       4.  (  )  JET DRIVE

          5.  (  )  OTHER                                                 5.  (  )  OTHER

USE:                                                            TYPE:

          1.  (  )  PLEASURE                                            1.  (  )  OPEN

          2.  (  )  DOCUMENTED                                    2.  (  )  CABIN

          3.  (  )  DEALER (For Demo Use)                      3.  (  )  HOUSE

          4.  (  )  COMMERCIAL PASSENGER             4.  (  )  OTHER

          5.  (  )  COMMERCIAL FISHING                    5.  (  )  AUX SAIL

          6.  (  )  COMMERCIAL OTHER                       6.  (  )  PWC

          7.  (  )  RENTAL                                                7.  (  )  PONTOON

          8.  (  )  EXEMPT                                                8.  (  )  INFLATABLE

FUEL:                                                          MARINE SANITATION DEVICE:

          1.  (  )  GASOLINE                                           1.  (  )  TYPE I-No Visible Solid Waste

          2.  (  )  DIESEL                                                  2.  (  )  TYPE II-Suspended Solid Waste

          3.  (  )  OTHER                                                  3.  (  )  TYPE III-Holding Tank

            4.  (  )  PORTABLE-Porta Pottie

MANUFACTURED:                                 

          1.  (  )  FACTORY BUILT                  

          2.  (  )  HOMEMADE

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HULL IDENTIFICATION NUMBER (12DIGITS)___________________________________

LENGTH OF VESSEL_________FT.__________INCHES    VESSEL NAME_____________

MAKE OF VESSEL___________________________________YEAR BUILT_____________

PREVIOUS  OWNER(s)________________________________________________________

PREVIOUS  REGISTRATION  NUMBER  ISSUED__________________________________

OWNER(s) NAME____________________________________________________________

MAILING  ADDRESS_________________________________________________________

CITY____________________________________STATE___________________ZIP_______

X_______________________________________ X_________________________________

 OWNER(s) SIGNATURE(s) IN INK

_________________________________ __________________________________________

SOCIAL SECURITY # FOR EACH OWNER, or TAX # FOR COMPANIES, or PASSPORT #

(     )__________________________________

DAYTIME TELEPHONE NUMBER
 

WORD.DOC