OATH AND
ACKNOWLEDG-
MENT
LIEN
STATUS
VESSEL OWNERSHIP AFFIDAVIT
B-203 REV. 3-2017
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
MARINE VESSEL SECTION
On The Web At ct.gov/dmv
NAME OF OWNER
OWNER'S ADDRESS
TO THE BEST OF YOUR KNOWLEDGE, ARE THERE ANY LIENS OR ENCUMBRANCES ON THE ABOVE DESCRIBED VESSEL?
I (we) are the lawful owners of the above described vessel. I (we) do not have knowledge of any liens or encumbrances on the said vessel, except as
indicated above. I (we) certify and attest that the vessel is not a documented or foreign documented vessel. I (we) understand that the statements made
herein to the Commissioner are given under penalty of false statement, in accordance with the provisions of section 53a-157b of the Connecticut General
Statutes, as amended. I (we) further understand that the Commissioner may revoke any certificate of title and/or registration issued in reliance on the
statements made herein, if the Commissioner becomes aware of any contrary or additional material facts, and that, in such event, I may have liability to any
third person (or persons) or party (or parties) who has (have) a legal interest in the above described vessel. I understand that if I make a statement which I
do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the above-cited laws.
NO YES (If "YES", indicate names and addresses below)
PRINTED NAME(S) OF OWNER(S)
SIGNATURE(S) OF OWNER(S)
X
DATE SIGNED
NAME OF CO-OWNER
CO-OWNER'S ADDRESS
LENGTH OF VESSEL
Ft. In.
HORSE POWER PRINCIPAL HULL MATERIAL MODEL YEAR
METAL (M)
(Aluminum)
PLASTIC (P)
(Fiberglass)
WOOD (W) RUBBER (R)
OTHER (O)
(Specify)
TYPE OF VESSEL
MAKE
MODEL HULL NUMBER (Required if built 1973 or later) PRIMARY COLOR OF HULL SECONDARY COLOR OF HULL
OPEN
(OPN)
CABIN
(CAB)
CANOE
(CAN)
HOUSE
(HOU)
PONTOON
(PON)
PERSONAL
WATERCRAFT (PWC)
(PWC Certificate No.)
OTHER (OTH)
(Specify)
FUEL
TYPE OF USE
GAS - G
NONE - N
DIESEL - D
OTHER - O
(Specify)
ELECTRIC - E
PROPULSION TYPE
MARINE SANITATION DEVICE (MSD) (See Boater's Guide or Owner's Manual)
YES (Check Type)
NO
TYPE I
TYPE I+III
TYPE II
TYPE II+III
TYPE III (Holding Tank)
PORTABLE TOILET
LIEN HOLDER
DATE OF LIEN SECOND LIEN HOLDER
DATE OF SECOND LIEN
ADDRESS OF LIEN HOLDER
ADDRESS OF SECOND LIEN HOLDER
SELLER
INFORMATION
NAME OF SELLER ADDRESS OF SELLER
DATE SOLD
LIST ANY KNOWN TITLE BRAND AND ISSUING STATE/JURISDICTION
STATE REASON OTHER DOCUMENTARY PROOF OF OWNERSHIP CANNOT BE SUBMITTED:
SAIL
WATER-JET
AIR THRUST
MANUAL
PROPELLER
OTHER (OT) (Specify)
PLEASURE
(REGULAR)
COMMERCIAL
FISHING (CF)
LIVERY (LY)
CHARTER
FISHING
COMMERCIAL PASSENGER
CARRYING
OTHER COMMERCIAL
OPERATION
