Form Dnr 8477 - Notarized Application For Historic Watercraft Identification Plate Form - Ohio Department Of Natural Resources

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Watercraft Use Only
State of Ohio
Department of Natural Resources
DIVISION OF WATERCRAFT
OH - ___ ___ ___ ___ - H H
2045 Morse Road, Building A • Columbus, Ohio 43229
1-877-4BOATER
• 614-265-6480 • Fax 614-784-5987
(in Ohio only)
OH - ___ ___ ___ ___ - ___ ___
watercraft.ohiodnr.gov
(if recreational)
NOTARIZED APPLICATION FOR HISTORIC WATERCRAFT IDENTIFICATION PLATE
For one-time application ($25) or ownership transfer ($10) of boats more than 25 years old.
The Historic ID Plate is valid only for a boat’s appearance in exhibitions, tours, and parades. If the boat is also used
recreationally, it also must have a valid Ohio Boat Registration (OH numbers and valid decal).
Print or type only. Please attach a copy of proof of ownership (eg. Ohio Title, Bill of Sale, MSO, Sales Receipt)
1.
o
NEW APPLICATION
o
TRANSFER OH - __ __ __ __ - H H
Previous Number OH - __ __ __ __ - __ __
(Historic ID Plate)
2. Choose ONE:
o
Boat is used ONLY for exhibits, parades or special events
o
Boat is used recreationally
3. Owner Name ____________________________________________________________________________________________
LAST
FIRST
MIDDLE INITIAL
Co-Owner Name _________________________________________________________________________________________
Daytime
LAST
FIRST
MIDDLE INITIAL
4. Home Address ______________________________________________________________ Phone (_____)________________
City ___________________________________ State ________ Zip Code _____________ County ______________________
5. Make of Boat _____________________________
Hull Identification No. __________________________ Year __________
6. Length: ____________Feet
___________ Inches
7. Type of Boat:
o
Open
o
Cabin
o
House/Pontoon
o
Row
o
Canoe/Kayak
o
Sail
o
PWC
o
Other
8. Type of Propulsion:
o
Outboard or Electric Motor
o
Inboard
o
Inboard/Out Drive
o
Jet
o
Air
o
Sail
o
Hand Powered
9. Hull Material:
o
Wood
o
Steel
o
Aluminum
o
Plastic
o
Fiberglass
o
Other
o
Inflatable
10. Motor Make _____________________________
HP ______________
Motor MFR’s Serial No. ___________________
Driver’s License
11. Date of Birth ______/______/______
_________/ ________________________________________
or Other I.D.
MM
DD
YY
STATE ISSuED
NuMBER (uSE TAx I.D. FOR BuSINESSES)
12. Boat Title Number _____________________________
o
No Title Required
13. Application Certification Statement (must be signed and verified in the presence of a Notary).
I (We) hereby certify that I (we) are the lawful owner(s) of the boat described above and that all information shown is correct.
I (We) further certify that this watercraft is more than 25 years old, is essentially as originally constructed.
I (We) understand that a Historic Watercraft Identification Plate is valid only for exhibitions, tours, and parades and is not valid for
recreational use of the boat.
_______________________________________________
_______________________________________________
SIgNATuRE OF OWNER
SIgNATuRE OF CO-OWNER
Sworn to before me and subscribed in my presence this ______ day of ________________________ , _______
MONTH
YEAR
_________________________________________________
NOTARY PUBLIC
My commission expires ______________________________
________________________________ County, State of Ohio
DNR 8477 01/14
Notarized Application for Historic Watercraft Identification Plate

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