Form 250 R11 – Fill Out and Use This PDF

Oregon State Marine Board

PO Box 14145

Salem, OR 97309

Phone: 503-378-8587 Fax: 503-378-4597

Email: Marine.Board@state.or.us

HOMEBUILT BOAT BUILDER CERTIFICATE

INSTRUCTIONS:

This form is to be used exclusively for boats that are HOMEBUILT regardless of the material type. HOMEBUILT boats are not factory production line boats but are boats constructed by an individual that is not registered with the United States Coast Guard as a builder/manufacturer. Manufactured kit boats that have not been assigned a hull identification number (HIN) are considered HOMEBUILT. Antique boats or boats reconstructed from an existing boat hull are not considered HOMEBUILT boats.

Please complete all sections of this form and submit it with an Application for Title and the proper fees (see reverse) to the State Marine Board at the above address. The Marine Board will assign a hull identification number for the boat. Please do not submit an application until boat construction is completed.

This form must be notarized.

STATEMENT OF BUILDER

BUILDER:

Name

Phone

Address

City

State

Zip Code

VESSEL DESCRIPTION

Length:

Type:

Year/Month Completed:

(See Reverse)

Open/Cabin

Material:

Majority of the material for construction was obtained from:

Name

Address

City		State	Zip

CERTIFICATE OF BUILDER

I hereby certify under penalty of law the information given by me on this Builder’s Certificate is true, correct, and complete to the best of my knowledge.

DateSignature of Builder

Subscribed and sworn to before me by _____________________________ on this ________ day of __________, 20 ___ .

	(builder)
Notary Public of Oregon	My commission expires: _______________

250-r11 - Rev. 11/09