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DO NOT MARK IN THIS SPACE--OFFICE USE ONLY
DL#_________________________________
PLEASE COMPLETE ENTIRE FORM BELOW:
STATE OF PRINCIPAL USE:
DELAWARE
HULL IDENTIFICATION
NUMBER (12DIGITS)____________________________________________
HULL:
PROPULSION:
1. (
) WOOD
1.
( )
OUTBOARD
2. (
) METAL
2.
( )
INBOARD
3. (
) INFLATABLE
3.
(
) IN/OB
4. (
) FIBERGLASS
4.
(
) JET DRIVE
5. (
) OTHER
5.
( )
OTHER
USE:
TYPE:
1.
( )
PLEASURE
1. ( )
OPEN
2. (
) DOCUMENTED
2.
(
) CABIN
3. (
) DEALER (For Demo Use)
3. ( )
HOUSE
4. (
) COMMERCIAL PASSENGER
4. ( )
OTHER
5. (
) COMMERCIAL FISHING
5. ( )
AUX SAIL
6. (
) COMMERCIAL OTHER 6. ( )
PWC
7. (
) RENTAL
7. ( )
PONTOON
8. (
) EXEMPT
8. ( )
INFLATABLE
MARINE SANITATION
DEVICE:
FUEL:
1. ( )
TYPE I-No Visible Solid Waste 1. (
) GASOLINE
2. (
) TYPE II-Suspended
Solid Waste 2. (
) DIESEL
3. ( ) TYPE
III-Holding Tank 3. (
) OTHER
4.
(
) PORTABLE-Porta
Pottie
MANUFACTURED:
1.
(
) FACTORY BUILT
VESSEL'S NAME___________________
2.
(
) HOMEMADE
-----------------------------------------------------------------------------------------------------------------------------------
LENGTH OF
VESSEL_________FT.__________INCHES
MAKE OF
VESSEL___________________________________YEAR BUILT_______________
PREVIOUS
OWNER(s)__________________________________________________________
PREVIOUS
REGISTRATION NUMBER
ISSUED____________________________________
OWNER(s)
NAME______________________________________________________________
MAILING
ADDRESS___________________________________________________________
CITY____________________________________STATE______________________ZIP______
X_______________________________________
X___________________________________
OWNER(s) SIGNATURE(s) IN INK
_______________________________________________________________________
SOCIAL
SECURITY # FOR EACH
OWNER, or TAX # FOR
COMPANIES, or PASSPORT #
(
)__________________________________
DAYTIME
TELEPHONE NUMBER
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