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Affidavit of Vessel Ownership

Affidavit of Vessel Ownership 16-10-20: A person who knowingly and willingly makes a false, fictitious or fraudulent any matter within the jurisdiction of any department or agency of state , upon conviction thereof, be punished by a fine of not more than $1000 or by imprisonment for not less than one nor more than five years, or both. Rev. 7-22-14 Return By: Upload to Customer Account at ; or Fax: 678-515-9470 or Email: or Mail: GA Dept. of Natural Resources, Box 934943, Atlanta, GA 31193-4943 Vessel INFORMATION THIS Vessel IS: New Used THIS Vessel KEPT IN WHICH GA COUNTY: _____ GA registration NUMBER (EX. GA1234ZZ) EXPIRATION DATE M___ ___ D ___ ___Y ___ ___ ___ ___ BOAT MANUFACTURER YEAR BUILT ____ ____ ____ ____ GA BOAT MODEL HULL IDENTIFICATION NUMBER (AFTER 1972, 12 OR 14 CHAR.) OUT-OF-STATE registration NUMBER BOAT LENGTH ____ FEET ____ INCHES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Vessel EQUIPPED WITH MARINE TOILET?

Provide copy of certificate of bond and the form “Surety Bond for Registration / Title.” D. Send the following: 1. “Affidavit of Vessel Ownership” form, and 2. all documents and information to GaDNR listed in B. and C. above, and 3. certificate of bond and “Surety Bond for Registration / Title” form (if applicable) for GaDNR review.

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