VESSEL VERIFICATION BOATS

STATE OF CALIFORNIA

®
DEPARTMENT OF MOTOR VEHICLES
A Public Service Agency THIS FORM MUST BE COMPLETED IN FULL
BOAT TYPE
VESSEL CF NUMBER STATE EXP. YEAR

VESSEL BUILDER YEAR BUILT LENGTH JON KAYAK PONTOON RUNABOUT CENTERBOARD KEEL
BOAT
FT . IN
HULL IDENTIFICATION NUMBER (HIN) ON VESSEL
HYDROPLANE BASS BOAT CANOE YACHT HOUSEBOAT

() VESSEL TYPE () PROPULSION () HULL MATERIAL () FUEL
A - Amphibious A - Aux/Sail A - Aluminum D - Diesel HIGH AIRBOAT CABIN DAY
B - Barge H - Hand Prop C - Cement PERFORMANCE CRUISER CRUISER
C - Cruiser I - Inboard P - Plastic/ G - Gasoline
H - House boat J - Jet Fiberglass
I - Inflatable N - Inb-Outb S - Steel X - Other TYPE PROPULSION
K - Kayak/Canoe O - Outboard W - Wood
O - Row boat S - Sail only X - Other INBOARD INBOARD
R - Runabout X - Other OUTBOARD
S - Sailboat
X - Other
VESSEL COLOR(S) OUTDRIVE OUTBOARD SAIL SAIL SAIL
JET OUTBOARD INBOARD

HIN GENERAL LOCATION: ATTACHED BY: HULL SHAPES

Transom - Outside Not visible Adhesive
Transom - Inside Screws Not applicable
CATAMARAN DEEP V FLAT PONTOON ROUND SEMI V TRI TUNNEL
Other: Round rivets Other: BOTTOM
TYPE:
Metal Plate Stamped Carved EXAMPLE
Burned Embossed/Imbedded Other: HIN (Hull Identification Number)
BOW
ENGINE MANUFACTURER:
ABC 45678 A4 84

TH
NG
RT

LE
ENGINE NO.: OUTDRIVE NO.: PO

D
AR
BEA
M
None—new engine or case supplement #

BO
Model

AR
Manufacturer's Hull Month/Year
HIN/ENGINE NO.

ST
I.D. Code (MIC) Serial of Year
HIN ENG HIN ENG HIN ENG Number Manufacture
RN
E
Appears okay See REMARKS ST TRA
Missing NSO
M

Altered/Tampered Cannot locate Needs CFZ assignment Jan - A June - F Nov - K

Illegible/Damaged None-Newly built Feb - B July - G Dec - L HULL IDENTIFICATION
NUMBER IN THIS
SUPPORTING DOCUMENTS: Mar - C Aug - H LOCATION
Agree with HIN None No HIN on documents Apr - D Sept - I
Disagree with HIN See REMARKS Oct - J
May - E
APPROXIMATE VESSEL VALUE
U.S. Coast Guard standards for hull identification numbers were established in 1972 and made mandatory on Aug. 1 1984.
(no uniform hull identification numbers prior to 1972).

I certify (or declare) under penalty of perjury under the laws of the State of California that the REMARKS
foregoing is true and correct. I further certify that I examined the vessel described above and
find the description of the vessel to be as indicated.
VERIFIER (PRINT NAME) TITLE/BADGE/ID NO.

ADDRESS CITY STATE

VERIFIED AT CITY STATE

Above address
Other (specify)
DATE VERIFIER'S SIGNATURE DAYTIME TELEPHONE NO.

X ( )
EMPLOYER
DMV Vessel Verifier Other (specify)
BOAT 111 (REV. 5/2014) WWW
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