Owner Information:

Name of corporation

Address (must be a physical address)

City

State

Zip

Federal Tax ID# / EIN

Phone Number

Fax Number

E-Mail address

State of Incorporation

Citizenship of C.E.O

Number of alien directors

Citizenship of Chairman of the board

Number of directors necessary to constitute a quorum

Vessel Information:

Year boat was built

Location where built

Make of boat

Length of Boat

Hull Material (select one) Wood Steel Aluminum Concrete Fibrous Reinforced Plastic (fiberglass)

You only need to complete section A or B:

A) un-documented boat

Hull Number

Name of Boat

Hailing Port (city and state)

State Registration number

B) Previously documented boat

Official Number

Former Name

New Name

Hailing port (city and state)

Miscellaneous Information

Endorsements (select one) Registry coastwise Oil spill response Fishery Coaswise (bowater only)

Primary Service (select one) Commercial fishing boat Fishing processing vessel freight ship Freight Barge Industrial Vessel Mobile offshore drilling unit Oil Recovery Offshore supply vessel Passenger (6 or fewer) Passenger (more than 6) Passenger Barge (6 or fewer) Passenger Barge (more than 6) Public Freight Public Tankship Public Vessel UNC Research Vessel School Ship Tank Barge Tank Ship Towing Vessel Unclassified Vessel Recreational

I confirm that I am a U.S. Citizen YES   NO

I have an original builders certificate YES  NO

I have an original bill of sale YES  NO