PFBC-734
(06/13)
Pennsylvania Fish & Boat Commission
AFFIDAVIT OF
Division of Licensing & Registration
PURCHASE/OWNERSHIP
P.O. Box 68900
Harrisburg, PA 17106-8900
866-262-8734 Fax: 717-705-7931
D
PA R
N
.
O NOT USE THIS FORM IF THE BOAT IS DISPLAYING A
EGISTRATION
UMBER OR A REGISTRATION OF ANOTHER STATE
This form is used to establish ownership of boats purchased at flea markets, yard/garage sales, auction/estate sales and other
private transactions where a bill-of-sale or Manufacturer’s Certificate of Origin (MCO) is not available and the boat was not
previously registered in Pennsylvania or any other state. Also, use this form to show ownership of a homemade or specially
constructed boat (include bills-of-sale for major components). This form is only valid when used with form REV-336, Application
for Boat Registration.
I/We ____________________________________________________________________________________________
whose residence is _________________________________________________________________________________
certify under penalty of law (18 Pa. C.S. §4904 (relating to unsworn falsification to authorities)) that the statements made
herein are true and correct to the best of my/our knowledge, information and belief. I/We certify that the boat described
below has been purchased from:
A.
Seller or Organization Information
Name of Seller or Organization
Address of Seller
City
State
Zip Code
Phone Number
B.
Description of Boat Purchased
Make of Boat
Model of Boat
Hull Identification Number (HIN) or Serial Number
Length of Boat
Purchase Date
Purchase Price
$
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Does the boat currently have a Pennsylvania or other state registration number?
Yes
No
If yes, place registration number here _________________________.
Signature of Purchaser
Date
Signature of Co-Purchaser
Date
For Official Use Only – Pennsylvania Fish and Boat Commission, Bureau of Law Enforcement
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NCIC Verification:
Reported Stolen
Not Reported Stolen
NCIC Verification Date: ____________________
NCIC BLE Investigator: _________________________