Propulsion 
    Outboard     
 Aux Sail 
    Inboard         
 Water Jet 
    Sail  
 Manual       
 Other 
    Gas     
  Diesel     
 Other 
INSTRUCTIONS: 
1. Complete in blue or black ink or print form.
2. All applicants claiming ownership must sign this affidavit.
 
 
 
   
I,____________________________________, a Notary Public in the District of St. Croix, United States Virgin Islands aforesaid hereby certify that 
the above name herein personally known to me to be the affiant in the foregoing affidavit, personally appeared before me this  day and having 
been by duly sworn deposes and says that the facts set forth in the above is true and correct. 
Witness my hand and official seal this _____day of _____________. 
My Commission expires:  ____________/___________/_________. 
 (SEAL)
Owner’s Name (last, first, middle initial or company name) 
Owner’s Legal Address (number and street) 
City 
State 
ZIP Code 
Owner’s Name (last, first, middle initial or company name) 
Owner’s Legal Address (number and street) 
City 
State 
ZIP Code 
HULL IDENTIFICATION NUMBER (HIN): 
Make 
Vessel # 
Year 
Model Name and/or Number 
Length (feet and inches) 
Horsepower 
 VESSEL OWNERSHIP AFFIDAVIT 
DEPARTMENT OF PLANNING AND NATURAL RESOURCES 
DIVISION OF ENVIRONMENTAL ENFORCEMENT 
OWNER INFORMATION 
VESSEL INFORMATION  
Check 
Appropriate 
Box 
Hull Material 
    Aluminum 
   Wood 
    Fiberglass 
   Plastic 
    Steel     
     Other 
Vessel Type 
    Open Cabin 
 Sailboats 
 Commercial 
    Hydroplane 
 Pontoon 
 Cruiser 
     Jet-Ski     
 Houseboat 
 Utility 
    Yacht 
 Amphibious 
 Other 
Fuel  
Watercraft Use             Pleasure 
    Fishing 
    Livery 
    Commercial 
    Recreational 
AFFIRMATION AND SIGNATURE 
This Affidavit is submitted to request the Division of Environmental Enforcement issue a Certificate of Registration. I agree to indemnify and hold harmless the 
Division of Environmental Enforcement from any liability arising from this transaction. I certify that I am the owner of said vessel listed herein and the 
information contained in this report, to the best of my knowledge is true and correct. 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) 
Printed Name of Owner 
Signature of Owner 
Date Signed (mm/dd/yyyy) 
Reason for Affidavit: