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RHODE ISLAND

DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

235 Promenade Street, Providence, RI 02908-5767

Office of Boat Registration & Licensing, 3

Floor, Room 360 (401) 222-6647

RI Party & Charter Boat License Application

Expiration February 28, 2018 Fee $25.00

Name of Business :_____________________________________( if applicable)

Name of Owner/Applicant: ____________________________________DOB:_________________

Address:____________________________City:_________________________State:_______ Zip:________

Height: _____ Weight: ________ Hair Color: _______ Eye Color:__________

Name of Vessel: _______________________

Boat Registration #__________________________

Homeport:_____________________________ Phone:_________________________

List name(s) of operator(s) & crew member(s) below. Should any names change during the period in which this

license is valid; DEM Office of Boat Registration & Licensing will be notified within five (5) business days:

____________________

______________________

_____________________

____________________

______________________

_____________________

____________________

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If additional space is required, please attach a separate sheet.

The following documents must be furnished (please attach):

A current copy of the operator’s USCG license to carry passengers for hire.

2. A current copy of the vessel’s “Certificate of Documentation” certifying that the vessel is

Documented “Coastwise”, or, if the vessel is under five (5) net tons, a copy of the vessel’s state registration.

3. Proof that the operator & crew are currently enrolled in a random drug-testing program that complies

With the Federal Government’s 46CFR “Drug Testing Program” regulations USCG Sector Boston 1-617-223-3000

4. A signed application form certifying that the vessel is & will be operated in compliance with all state and federal

Safety regulations for the vessel. (By signing this form, you are in agreement that the vessel will be operated in

compliance with all state and federal safety regulations for the vessel).

5. Complete the Taxation Certification pursuant to RIGL5-76 and 31-3 & submit along with

Application for Party/Charter Boat

Under penalty of law, I hereby certify that the above information is true and correct:

Applicant’s Signature____________________________________ Date: __________________

State of Rhode Island, County of ___________________

Sworn and subscribed before me on this _______ day of ____________, 20___

________________________________________

________________________ (Seal)

Notary Public Signature

My Commission Expires

Notes: Checks/Money Orders payable to State of RI – DEM & mail or deliver to the address below

Mail to: RI DEM, 235 Promenade St., Room 360, Providence, RI 02908

Ri Party & Charter Boat License Application Form - Rhode Island Department Of Environmental Management

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