Application for Motorboat Registration 120 State Street State of Vermont Montpelier, VT 05603-0001 DEPARTMENT OF MOTOR VEHICLES Agency of Transportation dmv.vermont.gov

State of Principle Operation

VT Registration # ______ Inboard  New (421)  New  Air Thrust  Diesel   Transfer (431) Sticker Expires ______Outboard  Propeller  Electric  Used  Pod-Drive  Renew (475) Length of Boat  Water Jet Fuel  Gas Previous Registration #   Sterndrive

Condition Rebuilt  Title Only ____ feet ____ inches Propulsion  Other  Other

Engine Drive Engine  Other

Make Model Year Color Hull ID Number (HIN) 1

Hull Material Vessel Type Primary Operation  Aluminum  Steel  Air Boat  Inflatable  PWC  Charter Fishing  Dealer/Demo  Fiberglass  Wood  Auxiliary Sail  Open Motorboat  Rowboat  Comm Fishing  Pleasure  Plastic  Other  Cabin Motorboat  Pontoon  Other  Comm Passenger  Rent/Lease  Rubber/Vinyl/Canvas  Houseboat  Comm Other

1 Owner License No Owner Federal ID Number Owner Gender Co-Owner License No Co-Owner Federal ID Number Co-Owner Gender 2

Owner Name Co-Owner Name

Mailing Address (PO Box or Street) Mailing Address (PO Box or Street)

City State ZIP City State ZIP

Physical Address (Street) Physical Address (Street)

City State ZIP City State ZIP

Date Of Birth If Name Has Changed, List Previous Name Date Of Birth If Name Has Changed, List Previous Name

Phone Number & Email Address:

3  Spouses  Joint Tenants  Tenants In Common  Business Partners  Transfer on Death (requires form T-07) Date of loan Date of birth (if individual) Lienholder VT license # (if individual) Name

4 Lienholder Address

Name of person or company Address of person or boat acquired from company boat acquired from 5 Signature of person or company Date purchased (agent) boat acquired from

I Certify That The VT Sales And Use Tax Has Been Collected Vermont Tax Number VT Dealer number 6 From The Purchaser And Paid To The VT Dept. Of Taxes 7 If claiming tax credit or transferring registration Section #7 must be completed in full 10 DO NOT WRITE IN SHADED AREA Purchase Purchaser Of Old Vessel $ Price Registration (37) City State On (Date) Tax Credit $ Tax (39) Net Taxable Year Make Plate Tax Exempt # $ Cost Title (03) HIN Tax (6%) $ Transfer (37)

Misc (37) 8 Signature of Owner & Co-Owner Date I certify that I am the owner of the vessel described above and same is properly equipped Other: X and in good mechanical condition. Statements and warrants herein are certified under penalty Total Fees X of 23 V.S.A. §202, §203 & §3829 $

Old #1 New # 1 New # 2 Index # Reg # Assigned Rater #

Registration Expires  225  231  233  454  465  490 C  2 Year  227  232  453  455  452  490 P /

VD-037 15M 11/2020 MTC

Application for Motorboat Registration 120 State Street State of Vermont Montpelier, VT 05603-0001 DEPARTMENT OF MOTOR VEHICLES Agency of Transportation dmv.vermont.gov

State of Principle Operation

VT Registration # ______ Inboard  New (421)  New  Air Thrust  Diesel   Transfer (431) Sticker Expires ______Outboard  Propeller  Electric  Used  Pod-Drive  Renew (475) Length of Boat  Water Jet Fuel  Gas Previous Registration #   Sterndrive

Condition Rebuilt  Title Only ____ feet ____ inches Propulsion  Other  Other Engine Drive Engine  Other

Make Model Year Color Hull ID Number (HIN) 1

Hull Material Vessel Type Primary Operation  Aluminum  Steel  Air Boat  Inflatable  PWC  Charter Fishing  Dealer/Demo  Fiberglass  Wood  Auxiliary Sail  Open Motorboat  Rowboat  Comm Fishing  Pleasure

 Plastic  Other  Cabin Motorboat  Pontoon  Other  Comm Passenger  Rent/Lease  Rubber/Vinyl/Canvas  Houseboat  Comm Other

1 Owner License No Owner Federal ID Number Owner Gender Co-Owner License No Co-Owner Federal ID Number Co-Owner Gender 2

Owner Name Co-Owner Name

Mailing Address (PO Box or Street) Mailing Address (PO Box or Street)

City State ZIP City State ZIP

Physical Address (Street) Physical Address (Street)

City State ZIP City State ZIP

Date Of Birth If Name Has Changed, List Previous Name Date Of Birth If Name Has Changed, List Previous Name

Phone Number & Email Address:

3  Spouses  Joint Tenants  Tenants In Common  Business Partners  Transfer on Death (requires form T-07) Date of loan Date of birth (if individual) Lienholder VT license # (if individual) Name 4 Lienholder Address

Name of person or company Address of person or boat acquired from company boat acquired from 5 Signature of person or company Date purchased (agent) boat acquired from

I Certify That The VT Sales And Use Tax Has Been Collected Vermont Tax Number VT Dealer number 6 From The Purchaser And Paid To The VT Dept. Of Taxes 7 If claiming tax credit or transferring registration Section #7 must be completed in full 10 DO NOT WRITE IN SHADED AREA Purchase Purchaser Of Old Vessel $ Price Registration (37) City State On (Date) Tax Credit $ Tax (39) Net Taxable Year Make Plate Tax Exempt # $ Cost Title (03) HIN Tax (6%) $ Transfer (37)

Misc (37) 8 Signature of Owner & Co-Owner Date I certify that I am the owner of the vessel described above and same is properly equipped Other: X and in good mechanical condition. Statements and warrants herein are certified under penalty Total Fees X of 23 V.S.A. §202, §203 & §3829 $

Old #1 New # 1 New # 2 Index # Reg # Assigned Rater #

Registration Expires

 225  231  233  454  465  490 C  2 Year

      227 232 453 455 452 490 P /

VD-037 15M 11/2020 MTC