Form Rv-1 - Boat Dealer Registration Instructions Page 21
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69New York State Office of Parks, Recreation and Historic Preservation
FOR OFFICE USE ONLY
APPLICATION FOR A BOAT
HULL IDENTIFICATION NUMBER
PLEASE PRINT WITH BLUE OR BLACK INK
IN THE BOXES PROVIDED
OWNER INFORMATION
DATE OF BIRTH
OWNER’S LAST NAME
FIRST NAME
MIDDLE INITIAL
MAILING ADDRESS (Include Street Number and Name, Rural Delivery, Box )
APT. #
DAYTIME PHONE NO.
Area Code
(
)
CITY OR TOWN
STATE
ZIP CODE
BOAT INFORMATION
HULL
YEAR/MAKE
LENGTH (FT)
WIDTH(FT)
COLOR
(If not homemade)
HULL MATERIAL
PROPULSION
FUEL
ORIGIN OF BOAT
o
o
o
o
o
o
o
o
WOOD
METAL
OUTBOARD
INBOARD
GAS
DIESEL
KIT
HOMEMADE
o
o
o
o
PLASTIC
INFLATABLE
I/O (IN/OUTBOARD)
ELECTRIC
o
o
FOUND
OTHER
o
o
o
o
o
FIBERGLASS
OTHER
SAIL
OTHER
NONE
LOCATION OF BOAT (ADDRESS)
LOCATION OF BOAT (COUNTY)
ENGINE INFORMATION (Optional)
ENGINE MAKE
YEAR
HORSEPOWER
CYLINDERS
SERIAL NO.(S)
CERTIFICATION: I certify that the information presented is true. My signature also authorizes the required inspection of
the boat described above, so that a hull identification number may be assigned.
-
SIGN HERE
(Sign name in full)
(Date)
FOR OFFICE USE ONLY
Name of Agent or Inspector
Enforcement Agency
Signature of Agent or Inspector
Inspection Date
1.
2.
3.
4.
REMARKS
Skip the Trip! Do Your DMV Business On-Line At:
PAGE 2 OF 2
OPS-420 (4/12)
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