DEPARTMENT OF GAME AND INLAND FISHERIES - CLIENT SERVICES
P.O. BOX 9930, HENRICO, VA 23228-9930
TELEPHONE: (866) 721-6911 WEBSITE: WWW.DGIF.VIRGINIA.GOV
NOTIFICATION OF CHANGE IN STATUS OF A NUMBERED VESSEL
BOAT OWNER: Use this form to report change in bo
at ownership, change in address, change in military
status or other changes in status. Any change in status must be reported within 15 days.
The new owner of a watercraft may operate vessel for 30 days from the date of purchase with a dated bill of sale and
the valid Certificate of Number (Registration) of the former owner. The new owner must apply for transfer of
ownership on forms provided by the Department of Game and Inland Fisheries.
BOAT DESCRIPTION:
Registration/Title Number:
Hull Identification Number:
Make:
Length:
Model Year:
CHANGE IN BOAT OWNERSHIP
I/we sold/transferred this boat on
to:
Date Sold
New Owner(s) Name:
Address:
Signature of Registered Owner(s):
X
X
CHANGE OF ADDRESS:
New Address:
CHANGE IN COUNTY/CITY GARAGED/DOCKED/PARKED: Code of Virginia Requires This Information Be
Provided to the Commissioner of Revenue:
County or City in Virginia where the boat is normally garaged, docked or parked:
Signature of Registered Owner(s):
X
X
, I am no longer Active Military.
X
X
CHANGE IN MILITARY STATUS: As of (date)
Signature of Registered Owner/(s)s:
OTHER CHANGES IN STATUS:
Boat will be registered in the State of:
Boat Abandoned as of (list date)
Boat Destroyed as of (list date)
How Destroyed:
Boat Stolen – Law Enforcement Agency Contacted (if any):
Other (Explain):
Signature of Registered Owner(s):
X
X
BRT-010 Change in Status May 2017
DOB: ____________ SSN4: ________ DRL4: ________
DOB: ____________ SSN4: ________ DRL4: ________
DOB: ____________ SSN4: ________ DRL4: ________
DOB: ____________ SSN4: ________ DRL4: ________
DOB: ____________ SSN4: ________ DRL4: ________
DOB: ____________ SSN4: ________ DRL4: ________
DOB: ____________ SSN4: ________ DRL4: ________
DOB:
____________ SSN4: ________ DRL4: ________
