Form Tc96-184 - Motor Boat Transaction Record/application For Registration And/or Title

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Kentucky Transportation Cabinet

TC 96-184

Rev:3/2016

Division of Motor Vehicle Licensing

Page 1 of 2

Motor Boat Transaction Record/Application for Registration and/or Title

 Duplicate  Title Only  Transfer  First Time  Salvage  Update

Check the type of application

desired.___________________________

 Lost

 Destroyed  Damaged  Illegible

 Other

If Duplicate is checked, the original Certificate of Title is:

____________

BOAT IDENTIFICATION SECTION

BOAT OWNER /BUYER SECTION

______________________________________________________

______________________________________________________________

KY #

DATE OF BIRTH

BOAT TYPE

HULL IDENTIFICATION

_____________________________________________________________

______________________________________________________________

YEAR

MAKE

MODEL

CITIZENSHIP OF APPLICANT

SEX

_____________________________________________________________

______________________________________________________________

LENGTH

BEAM

HULL MATERIAL

PROPULSION

COUNTY OF DOCKAGE

_____________________________________________________________

I HEREBY APPLY FOR REGISTRATION AND/OR A CERTIFICATE OF TITLE. I CERTIFY

FUEL TYPE

CAPACITY

USE

THAT THE DESCRIBED MOTORBOAT WILL BE OPERATED CONSISTENT WITH THE

CLASSIFICATION REQUESTED HEREIN, AND THE MARINE SANITATION DEVICE FOR

_____________________________________________________________

THE TOILET IS PROPERLY OPERATING AND PROPERLY USED FOR THE WATER

# TOILETS

TOILET TYPE

APPROVED

HORSEPOWER

BODY WHERE THE MOTORBOAT IS KEPT OR OPERATED. I FURTHER CERTIFY

UNDER THE PENALTY DESCRIBED HEREIN, THAT I HAVE SUPPLIED TRUE AND

CORRECT INFORMATION TO THE BEST OF MY KNOWLEDGE AND BELIEF.

_____________________________________________________________

HAS THE APPLICANT BEEN PREVIOUSLY LICENSED OR REGISTERED AS AN

YES

PURCHASE PRICE

PURCHASE DATE

OWNER?

*IF YES, WHEN AND BY WHAT STATE OR COUNTY?

_____________________________________________________________

* HAS THE APPLICANTS LICENSE REGISTRATION OR CERTIFICATE NUMBER BEEN

YES

MOTOR MAKE

YEAR

H.P

# MOTORS

CANCELLED, SUSPENDED, REVOKED, OR REFUSED?

* IF YES, GIVE DATE AND REASON.

_____________________________________________________________

MOTOR SERIAL #

YEAR PURCHASED

PURCHASE AMOUNT

Hail Damage

MOTOR BOAT BRAND DISCLOSURE: Check appropriate block if applicable:  Rebuilt

 Salvage

KRS 235.990 Any person who violates any of the provisions of this chapter or administrative regulations adopted under this chapter shall be fined not less than fifty dollars ($50) nor more than two hundred dollars ($200).

JOINT OWNERSHIP:  OR  AND (NOTE: If neither box is checked, the transfer shall require both signatures.)

_________________________________________________________

________________________________________________________

SSN/Federal ID #

NAME OF SELLER(S)

SELLER DEALER #.

NAME OF OWNER/BUYER(S)

_________________________________________________________

________________________________________________________

SSN/Federal ID #

STREET ADDRESS

NAME OF OWNER/BUYER(S)

_________________________________________________________

________________________________________________________

CITY

COUNTY

STATE

ZIP

ADDRESS

________________________________________________________

EMAIL ADDRESS

PHONE #

CITY

COUNTY

STATE

ZIP

________________________________________________________

EMAIL ADDRESS

PHONE NUMBER

I ( have) ( have not) applied for a loan in connection with the vehicle described herein and if not, I ( will) ( will not) apply for a loan within 30 days of this application.

I WARRANT THAT THE MOTORBOAT DESCRIBED ABOVE IS NOT SUBJECT TO AN

__________ ________________________________________________________________

UNTERMINATED LIEN AND THAT NO LOAN IN CONNECTION WITH THIS MOTORBOAT

FIRST LIENHOLDER

HAS NOR WILL BE APPLIED FOR BY SELLER WITHIN 30 DAYS OF THIS APPLICATION.

___________________________________________________________________________

ADDRESS

___________ ________________________________________________________________

COUNTY WHERE LIEN WILL BE FILED

__________________________________________________________

________________________________________________________

SELLER’S SIGNATURE

OWNER/BUYER(S) SIGNATURE(S)

__________________________________________________________

________________________________________________________

SELLER’S SIGNATURE

OWNER/BUYER(S) SIGNATURE(S)

Date of Transfer

__________________________________________________________

________________________________________________________

Attesting Official signature

Title

Attesting Official Signature

Title

_______

_____

_______

_____________

______

Subscribed and affirmed before me ng before me this

day of

Subscribed an affirmed before me this

day of

___________________________________________

__________________________________________

My commission expires

COUNTY CLERK USE ONLY

TYPE APPLICATION

DATE OF ISSUANCE

TITLE #

DECAL #.

__________________________________________________________________________________________________________________________________________________________________________________________________

Clerk Fee

State fee

SIGNATURE & TITLE OF ISSUER

COUNTY

DATE

I certify that the lien indicated to be filed has been noted into the automated system and that a title will be withheld for 30 days, or until financing statement and fees required are received, whichever occurs first.

Signature _______________________________________________

Date _________________

DO NOT ACCEPT TITLE SHOWING ANY ERASURES, ALTERATION, OR MUTILATIONS. SHALL BE COMPLETED IN BLUE OR BLACK INK.