Form Dnr-B-110 - Certification Of State Of Principal Use - Maryland Department Of Natural Resources
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2MARYLAND DEPARTMENT OF NATURAL RESOURCES
LICENSING & REGISTRATION SERVICE
1804 WEST STREET SUITE 300
ANNAPOLIS, MARYLAND 21401
CERTIFICATION OF STATE OF PRINCIPAL USE
This form is to be used only for vessels not used principally in Maryland.
PLEASE PRINT OR TYPE ALL INFORMATION
VESSEL DESCRIPTION:
Manufacturer _______________________________________________
Model _____________________ Year __________
Length ___________________
Hull ID Number _____________________________________
Current State Registration or USCG Number _________________________________________________________________
Total Purchase Price $ _____________________ Trade-in Value:$ ___________________ Net Purchase Price: $________________
VESSEL OWNER INFORMATION:
NOTE: INFORMATION MUST BE SPECIFIC TO THE LOCATION OF PRINCIPAL USE
Purchaser(s) _________________________________________________________________________________________________
or
Owner(s) ___________________________________________________________________________________________________
Address (Street address also required if P.O. Box)
________________________________________________________________________
City ______________________________________________ State _____________________________ Zip Code _______________
Driver’s License No. _____________________________________________ State of Issue _________________________________
Home Telephone No. (_______)____________________________________ Work Telephone No. (______)____________________
OWNER CERTIFICATION:
I certify under penalty of perjury that the vessel described above will be used principally in the State of ________________________,
and will be kept at (marina name and location or residence address) ____________________________________________________
___________________________________________________________________________________________________________
Purchaser/Owner(s) Printed name(s)
___________________________________________________________________________________________________________
Purchaser/Owner(s) Signature
Date Required
___________________________________________________________________________________________________________
Purchaser/Owner(s) Signature
Date Required
DEALER CERTIFICATION:
I hereby certify under penalty of perjury that I have advised the purchaser(s)/owner(s) of the vessel described above of Maryland
excise tax law. To the best of my knowledge, information and belief, no excise tax liability exists for this vessel.
____________________________________________________________________________________________________________
Dealer Signature
Date Required
___________________________________________________________________________________________________________
Dealership Name (Please Print)
Maryland Dealer Number
ST
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DNR-B-110 (Rev 5/10)
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copy - DNR
2
copy - State of principal use
3
copy - Dealer
4
copy-Owner
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