APPLICATION FOR VESSEL REGISTRATION AND CERTIFICATE …

1 NEWOWNER(S)/APPLICANT(S)INFORMATION(All owners' names and addresses must be listed. Use B-148 addendum if more than two owners)DMV USEONLYAUTHORIZED DEALER OR RETAILERSELLERINFORMATIONTAX EXEMPTIONS (All tax exemptions are reviewed by State of Connecticut Dept. of Revenue Services) APPLICATION FOR VESSELREGISTRATION AND CERTIFICATEOF NUMBER DECALB-148 REV. 10-2016 STATE OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLES60 STATE STREET, WETHERSFIELD, CTCertification(New owner(s) or applicant(s))CURRENT OUT OF STATE VESSEL NUMBERDOCUMENTED VESSEL NUMBER (US or foreign)STATE WHERE VESSEL IS PRIMARILY USED TYPE OF APPLICATIONNEWREGISTRATIONTRANSFER TO NEW OWNERCERTIFICATEOF (List previous number)NAME OF OWNER (Last, First, Middle Initial - or Company Name)OWNER'S CT OPERATOR'S LIC.

2 'S SEXCITIZENSHIPMFUSOTHERADDRESS OF OWNEROWNER'S SAFE BOATING CERTIFICATE 'S DATE OF BIRTHOWNER'S TELEPHONE NUMBER (Optional)OWNER'S RESIDENCE ADDRESS (If different than mailing address)DMV USE ONLYLENGTH OF POWERPRINCIPAL HULL MATERIALMODEL YEARALUMINUMPLASTIC (P)WOOD (W)RUBBER/VINYL/CANVASOTHER (O) (Specify)FOR SALES BY DEALER OR RETAILER OF VESSELSTOTAL SALES PRICETRADE-IN ALLOWANCENET SALES PRICESALES TAX COLLECTEDTRADE-IN INFORMATIONMAKEMODELYEARHULL NUMBERREG. NO. ON VESSEL WHEN TRADEDPURCHASER BOUGHT VESSEL WHILE RESIDING IN THE STATE OF:DATE PURCHASEDDATE REGISTERED DATE VESSEL FIRST MOVED TO CTPURCHASER PAID SALES OR USE TAXAMOUNT OF TAX (Show Receipt)WHERE WAS TAX PAID (City, State)THE ABOVE VESSEL WAS TRANSFERRED BY:AN IMMEDIATE FAMILY MEMBERA GOVERNMENT AGENCYAN EXEMPT ORGANIZATIONEXEMPT PERMIT NUMBERE -The VESSEL was registered in this person's name for 60 days or more in the following state.

3 OTHER (Specify)NAME OF LAST REGISTERED OWNER (Not a Dealer) IF DIFFERENT FROM SELLERVESSEL ISNEWUSEDPURCHASE DATECOMPLETE IF SALE IS BY OTHER THAN DEALER OR RETAILER OF VESSELSGROSS SALES PRICE (Show bill of Sale)XSIGNATURE(S) OF SELLER(S) OR AUTHORIZED AGENTCOMPANY NAME (If Agent)DATE SIGNEDDATE SIGNEDADDRESS OF SELLER(City or Town)(Number and Street)(State)(Zip Code)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 TITLEXSIGNATURE(S) OF OWNER(S) OR AUTHORIZED OFFICERI, the undersigned, declare under penalty of false statement, that information on this APPLICATION is true and complete to the best of my knowledge and OF VESSELMAKEMODELHULL IDENTIFICATION NUMBER (Required if built 1973 or later)PRIMARY COLOR OF HULLSECONDARY COLOR OF HULLOPEN MOTORBOATAUXILIARY SAILCANOEHOUSEBOATPONTOONFUELTYPE OF USEGAS - GDIESEL - DOTHER - O (Specify)ELECTRIC - EPROPULSION TYPESAILWATER-JETPLEASURE(REGULAR)COMMER CIAL FISHING (CF)LIVERY (LY)MARINE SANITATION DEVICE (MSD) (See Boater's Guide or Owner's Manual)YES (Check Type)NOTYPE INAME OF SELLERTYPE I+IIITYPE IITYPE II+IIITYPE III (Holding Tank)PORTABLE TOILETCO-OWNER'S DATE OF BIRTHLIEN-HOLDER(If vesselpurchase wasfinanced)

4 LIEN-HOLDER FINANCING VESSEL PURCHASE FOR CURRENT OWNERDATE OF LIENDATE OF SECOND LIENSECOND LIEN-HOLDER (If Any)ADDRESS OF LIEN-HOLDERADDRESS OF SECOND LIEN-HOLDERTITLESIGNATURE OF AUTHORIZED DEALER OR RETAILERXSALES TAX NUMBERAUTHORIZATION NUMBERCOMPANY NAMEI, the undersigned, certify that I am the holder of a Connecticut Sales and Use Tax 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 'S CT OPERATOR'S LIC. OF CO-OWNER (Last, First, Middle Initial - or Company Name)ADDRESS OF CO-OWNERLIST ANY KNOWN TITLE BRAND AND ISSUING STATE/JURISDICTIONFIBERGLASSSTEELENGINE TYPEINBOARD (IN)OUTBOARD (OB)AIR THRUSTMANUALPROPELLEROTHER (OT) (Specify)POD DRIVESTERNDRIVEOTHER (OT) (Specify)CHARTER FISHINGCOMMERCIAL PASSENGERCARRYING OTHERCOMMERCIAL OPERATIONCABIN MOTORBOATINFLATABLE BOATSAIL ONLYAIR BOATPWCROWBOATOTHEREXPIRATION DATECT.

5 NO. ON VESSEL PURCHASEDAPRIL 30,PREVIOUS TITLE NUMBERPADDLECRAFTSTATESTATENEW CT NUMBER ISSUEDI, the undersigned, declare under penalty of false statement, that information on this APPLICATION is true and complete to the best of my knowledge and INFORMATIONWhen a CT number has been assigned to a VESSEL , this number will remain with the VESSEL throughout the ownership change. Each new owner must apply for his own CERTIFICATE for this CERTIFICATE - Any person who transfers to another ownership of a VESSEL numbered or awarded a REGISTRATION decal by this state or presents evidence that such VESSEL has been stolen, lost, destroyed, sold, or traded to a dealer upon surrendering the outstanding CERTIFICATE of number or CERTIFICATE of REGISTRATION decal, may have another VESSEL numbered in his name for the remainder of the numbering period, or may have another REGISTRATION decal issued in his name for the remainder of the REGISTRATION period, upon payment of a "remainder fee", if any is due CGS Section 15-142(b).

6 CERTIFICATE OF DECAL - Each VESSEL with respect to which the owner holds a valid CERTIFICATE of number awarded by the United States pursuant to the provisions of the Federal Boat Safety Act of 1971 or if the owner holds a valid CERTIFICATE of number awarded by another state, which VESSEL is used upon the waters of this state for more than sixty (60) days in any calendar year, shall be required to display a Connecticut REGISTRATION decal. The owner is required to hold a valid, effective CERTIFICATE or REGISTRATION awarded by this state and the REGISTRATION decal must be displayed as directed by the Commissioner of Environmental Protection. Sec. 15-142 PRICE - A bill of sale is required as evidence of the amount paid for the TAX PAID IN ANOTHER STATE - In order to obtain credit for Sales Tax paid to another jurisdiction, you must present proof of payment in the form of an official receipt or sales tax reflected on an , TRADE, SWAP - When two individuals trade vessels, each must pay Sales Tax on the average market value as determined by the Department of Revenue FOR PREPARATION OF APPLICATION (Any Items Not Mentioned AreSelf-Explanatory)TYPE OF APPLICATION - If owner has acquired VESSEL with no CT number, check first box.

7 (An example of CT number CT 12 D). if owner has acquired a VESSEL with a CT number already on the hull, check the 2nd box. If applying for a CERTIFICATE of decal check 3rd box (see general Information above). If renewing, check 4th box. If applying for a duplicate, check 5th box. If changing information on current REGISTRATION , check 6th box. If applying for Remainder CERTIFICATE , check 8th box (see general information above for qualifying factors).OWNER'S NAME - Print last name, first name and middle initial of all owners. If VESSEL has more than one owner, print address of owner to whom the CERTIFICATE will be mailed. A firm, company, or corporation must insert Its official name (not officer's name).NAME OF STATE WHERE CURRENTLY REGISTERED, OUT-OF-STATE VESSEL NO.

8 , DOCUMENTED VESSEL GIVE DOCUMENTED NAME AND NUMBER -Complete only if applying for a CERTIFICATE of decal or Title. Coast Guard document, Title or out-of-state CERTIFICATE must be shown. See form B-220 available online at - Horizontal distance between the foremost part of the stem and the after most part of the stern, excluding bowsprits, bumpkins, rudders, outboard motor brackets and similar fittings or - Number of horsepower or largest motor used to power MATERIAL - Check proper box to describe principal material used in constructing hull of OF VESSEL - State the name or firm which built your VESSEL or prove the trade name. If you built the VESSEL yourself, enter "Homemade." If make is unknown, print "Unknown."MODEL- Insert manufacturers model name or number.

9 If model is unknown print "unknown."HULL IDENTIFICATION NUMBER - This is the 12 character code put on the boat by the manufacturer when it was built. It must be inserted if your VESSEL is 1973 or DEALER OR RETAILER SECTION - For Dealer use INSTRUCTIONS FOR THOSE CLAIMING TAX EXEMPTION(Any items Not Mentioned Are Self-Explanatory)TRANSFERS BETWEEN RELATIVES: (Mother, Father, Wife, Husband, Daughter, Son, Sister, Brother)- Transfers between in-laws not eligible for tax TO CONNECTICUT EXEMPT ORGANIZATION OR TO A GOVERNMENTAL AGENCY:- Connecticut exemption number must appear In appropriate box on OR USE TAX PAID TO ANOTHER JURISDICTION:- Invoice or other evidence must be presented reflecting amount of sales or use tax REASONS:-GIFT: If VESSEL received as a gift, a notarized affidavit by the donor must accompany this law requires that every VESSEL (including any used in livery service) operated upon the waters of this state shall be numbered except as otherwise provided in Section 15-142 and Section 15-143 of the Connecticut General YEAR - Insert the year in which VESSEL was - Check proper SANITATION DEVICE INFORMATIONTYPE I MSD - Treats sewage so that discharged effluent meets specified standards for bacteria content and contains no visible floating II MSD - Similar to Type I, but must meet a higher standard of sewage III MSD - Retains untreated sewage in a holding tank for shore based disposal or discharge beyond the Territorial Seas Demarcation Line.

10 Does not treat TYPE - Check proper box.