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Get WATERCRAFT OWNERSHIP AFFIDAVIT

OWNER INFORMATION Owner s Name last first middle initial or company name Owner s Legal Address number and street City State ZIP Code WATERCRAFT INFORMATION Hull Identification Number HIN please enter in spaces below Make Model Name and/or Number Horsepower Length feet and inches Hull Material Check Appropriate Box Year Propulsion Boat Type Aluminum Wood Runabout Airboat Hydrofoil Outboard Auxiliary Sail Fiberglass Plastic Sailboat Commercial Hydroplane Inboard Water Jet Steel Other Pontoon Cruiser Jet-Ski Sail Manual Houseboat Hovercraft Utility Yacht Amphibious Gasoline Fuel Diesel Watercraft Use Pleasure Fishing Livery Passenger for Hire Date of Purchase or Date of Assembly mm/dd/yyyy Watercraft Valued at Less Than 3 000 When New Reason Purchase Price Watercraft Purchased Prior to January 1 1986 Privately Assembled Watercraft Estimated Value When New required for registration AFFIRMATION AND SIGNATURE This affidavit is submitted to request the Indiana Bureau of Motor Vehicles issue an Indiana Certificate of Title and/or Certificate of Registration. I agree to indemnify and hold harmless the Indiana Bureau of Motor Vehicles from any liability arising from this transaction. I understand that making a false statement may constitute the crime of perjury. Printed Name of Owner Signature of Owner Date Signed mm/dd/yyyy BMV USE ONLY Visit ID Date Processed mm/dd/yyyy. Reset Form WATERCRAFT OWNERSHIP AFFIDAVIT State Form 55100 9-12 Indiana Bureau of Motor Vehicles INSTRUCTIONS Complete in blue or black ink or print form. An applicant who is unable to present ownership documentation for a watercraft due to one of the reasons listed below may present this form to obtain a certificate of title and/or certificate of registration. All applicants claiming ownership must sign this affidavit. OWNER INFORMATION Owner s Name last first middle initial or company name Owner s Legal Address number and street City State ZIP Code WATERCRAFT INFORMATION Hull Identification Number HIN please enter in spaces below Make Model Name and/or Number Horsepower Length feet and inches Hull Material Check Appropriate Box Year Propulsion Boat Type Aluminum Wood Runabout Airboat Hydrofoil Outboard Auxiliary Sail Fiberglass Plastic Sailboat Commercial Hydroplane Inboard Water Jet Steel Other Pontoon Cruiser Jet-Ski Sail Manual Houseboat Hovercraft Utility Yacht Amphibious Gasoline Fuel Diesel Watercraft Use Pleasure Fishing Livery Passenger for Hire Date of Purchase or Date of Assembly mm/dd/yyyy Watercraft Valued at Less Than 3 000 When New Reason Purchase Price Watercraft Purchased Prior to January 1 1986 Privately Assembled Watercraft Estimated Value When New required for registration AFFIRMATION AND SIGNATURE This affidavit is submitted to request the Indiana Bureau of Motor Vehicles issue an Indiana Certificate of Title and/or Certificate of Registration. I agree to indemnify and hold harmless the Indiana Bureau of Motor Vehicles from any liability arising from this transaction. I understand that making a false statement may constitute the crime of perjury.

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