Application For Vessel Registration And Certificate Of Number Decal

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APPLICATION FOR VESSEL
REGISTRATION AND CERTIFICATE
OF NUMBER DECAL
B-148 REV. 11-2007
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
60 STATE STREET, WETHERSFIELD, CT
AFFIX STICKER HERE
(DMV COPY ONLY)
CT. NO. ON VESSEL PURCHASED
VESSEL NUMBER
ISSUE BRANCH
FEE DUE
HIGHEST FEE PAID
EXPIRATION DATE
STATE
NUMBER
APRIL 30,
VOID UNLESS VALIDATED ABOVE BY DMV
CURRENT OUT OF STATE VESSEL NUMBER
DOCUMENTED VESSEL NUMBER
STATE WHERE VESSEL IS USED
TYPE OF APPLICATION
NEW
TRANSFER TO
CERTIFICATE
INFO.
REMAINDER
RENEWAL
DUPLICATE
REGISTRATION
NEW OWNER
OF DECAL
CHANGE
(List previous number)
NAME OF OWNER (Last, First, Middle Initial - or Company Name)
IF CO-OWNERSHIP
OWNER'S CT OPERATOR'S LIC. NO.
OWNER'S SEX
AND
OR
M
F
(Common)
(Joint)
NAME OF CO-OWNER (Last, First, Middle Initial - or Company Name)
OWNER'S DATE OF BIRTH
CO-OWNER'S DATE OF BIRTH
CITIZENSHIP
US
OTHER
OWNER'S MAILING ADDRESS
OWNER'S SAFE BOATING CERTIFICATE NO.
OWNER'S TELEPHONE NUMBER (Optional)
OWNER'S RESIDENCE ADDRESS (If different than mailing address)
NEW
OWNER(S)/
LENGTH OF VESSEL
HORSE POWER
PRINCIPAL HULL MATERIAL
YEAR BUILT
APPLICANT(S)
METAL (M)
PLASTIC (P)
OTHER (O)
INFORMATION
WOOD (W)
RUBBER (R)
Ft.
In.
(Aluminum)
(Fiberglass)
(Specify)
TYPE OF VESSEL
(PWC Certificate No.)
OTHER (OTH)
OPEN
CABIN
CANOE
HOUSE
PONTOON
PERSONAL
(Specify)
(OPN)
(CAB)
(CAN)
(HOU)
(PON)
WATERCRAFT (PWC)
MAKE
MODEL
HULL NUMBER (Required if built 1973 or later)
PRIMARY COLOR OF HULL
SECONDARY COLOR OF HULL
INBOARD
FUEL
PROPULSION
SAIL
JET INBOARD
JET OUTBOARD
OUTBOARD
INBOARD
OUTBOARD
ONLY
(IO)
GAS - G
DIESEL - D
ELECTRIC - E
(SA)
(JI)
(JO)
(OB)
(IN)
SAIL
OTHER - O
NO PRO-
(SO)
NONE - N
SAIL
OTHER
(SI)
(OT)
(W/Aux. outboard power)
(Specify)
PULSION
(NO)
(W/Aux. inboard power)
(Specify)
TYPE OF USE
MARINE SANITATION DEVICE (MSD) (See Boater's Guide or Owner's Manual)
COMMERCIAL
OTHER (YY)
FISHING (CF)
PLEASURE (PL)
YES
TYPE I
TYPE II
TYPE III (Holding Tank)
(Check Type)
(Specify)
COMMERCIAL
LIVERY (LY)
NO
TYPE I+III
TYPE II+III
PORTABLE TOILET
PASSENGER (CP)
I, the undersigned, declare under penalty of false statement, that information on this application is true and complete to the best of my knowledge and belief.
Certification
SIGNATURE(S) OF OWNER(S) OR AUTHORIZED OFFICER
OFFICERS TITLE
DATE SIGNED
(New owner(s)
or applicant(s))
X
I, the undersigned, hereby declare that this boat was sold or transferred as stated in this application.
NAME OF SELLER
ADDRESS OF SELLER
(Number and Street)
(City or Town)
(State)
(Zip Code)
SIGNATURE(S) OF SELLER(S) OR AUTHORIZED AGENT
COMPANY NAME (If Agent)
DATE SIGNED
Certification
X
(Seller)
NAME OF LAST REGISTERED OWNER (Not a Dealer) IF DIFFERENT FROM SELLER
FOR SALES BY DEALER OR RETAILER OF VESSELS
TOTAL SALES PRICE
VESSEL IS
PURCHASE DATE COMPLETE IF SALE IS BY
GROSS SALES PRICE (Show bill of Sale)
OTHER THAN DEALER OR
NEW
USED
TRADE-IN ALLOWANCE
RETAILER OF VESSELS
I, the undersigned, certify that I am the holder of a Connecticut Sales and Use Tax
AUTHORIZATION NUMBER
NET SALES PRICE
Permit and the vessel described on this form was sold to the purchaser on the date
shown and all taxes due on this sale have been collected.
SALES TAX COLLECTED
AUTHORIZED
COMPANY NAME
DEALER OR
TRADE-IN INFORMATION
RETAILER
SIGNATURE OF AUTHORIZED DEALER OR RETAILER
SALES TAX NUMBER
MAKE
MODEL
YEAR
X
HULL NUMBER
THE ABOVE VESSEL WAS TRANSFERRED BY:
OTHER (Specify)
TAX
AN IMMEDIATE
The vessel was registered in this person's name
REG. NO. ON VESSEL WHEN TRADED
EXEMPTIONS
FAMILY MEMBER
for 60 days or more in the following state:
(All tax
EXEMPT PERMIT NUMBER
DMV USE ONLY
exemptions are
A GOVERNMENT
AN EXEMPT
E -
reviewed by
AGENCY
ORGANIZATION
State of
AMOUNT OF TAX (Show Receipt)
WHERE WAS TAX PAID (City, State)
PURCHASER
Connecticut
PAID SALES
OR USE TAX
Dept. of
Revenue
DATE PURCHASED
DATE REGISTERED DATE VESSEL FIRST MOVED TO CT
PURCHASER BOUGHT
VESSEL WHILE RESIDING
Services)
IN THE STATE OF:

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