Mississippi Motor Boat Registration Application Form printable pdf download

• ALL SHADED AREAS MUST BE COMPLETED • SEE BACK FOR INSTRUCTIONS •

Date Received

CCK $__________ MO $ __________ CASH $ __________

Return Date

FOR OFFICE USE

____________

CCK or MO # ______________________CC$___________

____________

MISSISSIPPI MOTOR BO T

CHECK ONE

q New Application

MS Registration Number

REGISTR TION

PPLIC TION

q Transfer

Fees Effective January 1, 2010

q Renewal

FOR FASTER SERVICE RENEW AT:

q Duplicate

•

FOR OFFICE USE

Any license agent location

Call 1-800-5GO-HUNT 24 hours a day

Less than 16 feet ..................$10.20

40 feet and over....................$47.70

REGISTR TION

16 to less than 26 ................$25.20

Dealer number ......................$40.20

26 feet to less than 40 ..........$47.70

Duplicate ................................$7.70

VALID FOR THREE (3) YEARS

NOTICE: Proof of Mississippi Sales Tax to accompany all new and used boats bought from an out-of-state or in-state dealer along

with dealer’s invoice. A copy of a notarized or witnessed bill of sale must accompany all applications if boat is purchased from an

individual. If this boat has been registered in your name in another state, please send a copy of that registration in lieu of a bill of sale.

First Name or Name of Business

Middle

Last

Date of Birth

Other Phone

E-Mail

Home Phone

Mailing Address

City

State

County

Zip Code

Driver’s License # / Social Security #

D.L. State

Previous Owner

ALL BOATS MUST HAVE A HULL

PPLIC NT’S SIGN TURE REQUIRED *

IDENTIFICATION OR SERIAL NUMBER.

SIGN

If not, boat must be inspected. Please call your local

HERE

Region Office for additional information.

Signature Certifies Ownership

Date

Boats Built Prior To Nov. 1, 1972 MUST Give Serial Number:

Boats Built After Nov. 1, 1972 MUST Give 12 DIGIT Hull I.D. #:

Make of Boat

Year of Boat

Present Registration Number on Boat

Feet:

Inches:

HULL MATERIAL

BOAT USE

PROPULSION

FUEL TYPE

TYPE OF BOAT

1. q Fiberglass

1. q Personal Pleasure

1. q Outboard

1. q Gasoline

1. q Open

7. q Jet Ski

2. q Aluminum

2. q Rental/Lease

2. q Inboard/Outboard

2. q Diesel

2. q Cabin Powered 8. q House Boat

3. q Wood

3. q Commercial Fishing

3. q Inboard

3. q Other

3. q Auxiliary

9. q Paddle Boat

4. q Steel

4. q Other

4. q Electric

4. q Sail Boat

10.q Air Boat

5. q Other

5. q Commercial Pleasure

5. q Sail

5. q Jet Boat

11.q Other

6. q Inflatable

6. q Dealer

6. q Jet

6. q Canoe

12. q Pontoon

7. q Agency

Saltwater Fishing: q Yes q No

U.S. Citizenship: q Yes q No

Trailer Serial Number

First Name:

Middle Initial:

Last Name:

Date of Birth:

Social Security or DL Number:

Co-Owner

OPTION L OUTBO RD MOTOR INFORM TION

Motor 1 (Serial Number)

Motor 1 (Manufacturer)

Horse Power

Motor 2 (Serial Number)

Motor 2 (Manufacturer)

Horse Power

Make check or money order payable to MS Dept. of Wildlife, Fisheries, and Parks • Boat Registration Div.• 1505 Eastover Drive • Jackson, MS 39211-6374

DET CH

ND KEEP WITH VESSEL UNTIL CERTIFIC TE NUMBER IS RECEIVED

Name __________________________________________ Address ____________________________________________________________

City ____________________________________________ State _____________________________________________Zip Code ___________

Make of Boat ____________________________________ HIN or SERIAL # ______________________________________________________

I Hereby Certify on ________________________________ I made application for certification of number for above described boat.

Valid for 60 days of issue. Carry on board when the vessel is being operated.

(OVER)

UNDER PENALTY OF PERJURY THIS INFORMATION IS TRUE AND CORRECT. __________________________________________________________

Revised 2-2012

Signature of Owner

Mississippi Motor Boat Registration Application Form

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