Form B-148 - Application For Vessel Registration And Certificate Of Number Decal

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APPLICATION FOR VESSEL

STATE OF CONNECTICUT

REGISTRATION AND CERTIFICATE

DEPARTMENT OF MOTOR VEHICLES

OF NUMBER DECAL

60 STATE STREET, WETHERSFIELD, CT

B-148 REV. 10-2016

NEW CT NUMBER ISSUED

PREVIOUS TITLE NUMBER

STATE

CT. NO. ON VESSEL PURCHASED

EXPIRATION DATE

APRIL 30,

DMV USE

ONLY

CURRENT OUT OF STATE VESSEL NUMBER

DOCUMENTED VESSEL NUMBER (US or foreign)

STATE WHERE VESSEL IS PRIMARILY USED

STATE

TYPE OF APPLICATION

NEW

TRANSFER TO

CERTIFICATE

INFO.

REMAINDER

RENEWAL

DUPLICATE

TITLE

REGISTRATION

NEW OWNER

OF DECAL

CHANGE

(List previous number)

NAME OF OWNER (Last, First, Middle Initial - or Company Name)

OWNER'S CT OPERATOR'S LIC. NO.

OWNER'S SEX

ADDRESS OF OWNER

OWNER'S DATE OF BIRTH

CO-OWNER'S DATE OF BIRTH

CITIZENSHIP

OTHER

NAME OF CO-OWNER (Last, First, Middle Initial - or Company Name)

CO-OWNER'S CT OPERATOR'S LIC. NO.

ADDRESS OF CO-OWNER

OWNER'S SAFE BOATING CERTIFICATE NO.

OWNER'S TELEPHONE NUMBER (Optional)

NEW

OWNER(S)/

APPLICANT(S)

OWNER'S RESIDENCE ADDRESS (If different than mailing address)

LIST ANY KNOWN TITLE BRAND AND ISSUING STATE/JURISDICTION

INFORMATION

(All owners'

names and

LENGTH OF VESSEL

PRINCIPAL HULL MATERIAL

MODEL YEAR

HORSE POWER

ALUMINUM

FIBERGLASS

RUBBER/VINYL/CANVAS

addresses must

OTHER (O) (Specify)

STEEL

PLASTIC (P)

WOOD (W)

Ft.

In.

be listed. Use

B-148

TYPE OF VESSEL

PONTOON

AUXILIARY SAIL

SAIL ONLY

PADDLECRAFT

HOUSEBOAT

ROWBOAT

CANOE

addendum if

OPEN MOTORBOAT

CABIN MOTORBOAT

PWC

OTHER

INFLATABLE BOAT

AIR BOAT

more than two

owners)

MAKE

MODEL

HULL IDENTIFICATION NUMBER (Required if built 1973

PRIMARY COLOR OF HULL SECONDARY COLOR OF HULL

or later)

FUEL

PROPULSION TYPE

PROPELLER

SAIL

WATER-JET

GAS - G

DIESEL - D

ELECTRIC - E

MANUAL

AIR THRUST

OTHER - O (Specify)

OTHER

(OT) (Specify)

TYPE OF USE

ENGINE TYPE

INBOARD

POD DRIVE

(IN)

OTHER

(OT) (Specify)

CHARTER

PLEASURE

COMMERCIAL

OTHER

OUTBOARD

STERNDRIVE

(OB)

FISHING

(REGULAR)

FISHING (CF)

COMMERCIAL

MARINE SANITATION DEVICE (MSD) (See Boater's Guide or Owner's Manual)

OPERATION

COMMERCIAL

LIVERY (LY)

YES

TYPE I

TYPE II

TYPE III (Holding Tank)

(Check Type)

PASSENGER

CARRYING

TYPE I+III

TYPE II+III

PORTABLE TOILET

LIEN-HOLDER FINANCING VESSEL PURCHASE FOR CURRENT OWNER

DATE OF LIEN

SECOND LIEN-HOLDER (If Any)

DATE OF SECOND LIEN

LIEN-HOLDER

(If vessel

ADDRESS OF LIEN-HOLDER

purchase was

ADDRESS OF SECOND LIEN-HOLDER

financed)

I, the undersigned, declare under penalty of false statement, that information on this application is true and complete to the best of my knowledge and belief.

Certification

SIGNATURE(S) OF OWNER(S) OR AUTHORIZED OFFICER

OFFICERS TITLE

DATE SIGNED

(New owner(s)

or applicant(s))

I, the undersigned, declare under penalty of false statement, that information on this application is true and complete to the best of my knowledge and belief.

NAME OF SELLER

ADDRESS OF SELLER

(Number and Street)

(City or Town)

(State)

(Zip Code)

SIGNATURE(S) OF SELLER(S) OR AUTHORIZED AGENT

COMPANY NAME (If Agent)

DATE SIGNED

SELLER

INFORMATION

NAME OF LAST REGISTERED OWNER (Not a Dealer) IF DIFFERENT FROM SELLER

FOR SALES BY DEALER OR RETAILER OF VESSELS

TOTAL SALES PRICE

VESSEL IS

PURCHASE DATE COMPLETE IF SALE IS BY

GROSS SALES PRICE (Show bill of Sale)

OTHER THAN DEALER OR

NEW

USED

TRADE-IN ALLOWANCE

RETAILER OF VESSELS

THE ABOVE VESSEL WAS TRANSFERRED BY:

OTHER (Specify)

NET SALES PRICE

TAX

AN IMMEDIATE

The vessel was registered in this person's name

EXEMPTIONS

FAMILY MEMBER

for 60 days or more in the following state:

SALES TAX COLLECTED

(All tax

EXEMPT PERMIT NUMBER

exemptions are

A GOVERNMENT

AN EXEMPT

TRADE-IN INFORMATION

E -

reviewed by

AGENCY

ORGANIZATION

State of

AMOUNT OF TAX (Show Receipt)

WHERE WAS TAX PAID (City, State)

MAKE

MODEL

YEAR

PURCHASER

Connecticut

PAID SALES

OR USE TAX

Dept. of

HULL NUMBER

Revenue

DATE PURCHASED

DATE REGISTERED DATE VESSEL FIRST MOVED TO CT

PURCHASER BOUGHT

Services)

VESSEL WHILE RESIDING

REG. NO. ON VESSEL WHEN TRADED

IN THE STATE OF:

DMV USE ONLY

I, the undersigned, certify that I am the holder of a Connecticut Sales and Use Tax

AUTHORIZATION NUMBER

Permit and the vessel described on this form was sold to the purchaser on the date

shown and all taxes due on this sale have been collected.

COMPANY NAME

AUTHORIZED

DEALER OR

RETAILER

SIGNATURE OF AUTHORIZED DEALER OR RETAILER

SALES TAX NUMBER

I, the undersigned, declare under penalty of false statement, that information on this application is true and complete to the best of my knowledge and belief.