• ALL SHADED AREAS MUST BE COMPLETED • SEE BACK FOR INSTRUCTIONS •
FOR OFFICE USE
Date Received: ___________ Payment Type: __________ Payment Amount: $ _________
MS Registration Number
MI-
Less than 16 feet |
$10.20 |
16 to less than 26 |
$25.20 |
26 feet and over |
$47.70 |
Dealer number |
.............. |
$40.20 |
Duplicate |
$7.70 |
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MISSISSIPPI MOTOR BOAT REGISTRATION APPLICATION
5 ( *,6 75 $ 7,219$ / ,') 25 7+5 ( ( < ( $ 5 6
Individual$ SS FDW RQ
CHECK ONE
oNew Application o Transfer
o Renewal o Duplicate
Provide Proof of Mississippi Sales Tax to accompany all new and used boats purchased from an out-of-state dealer or in-state dealer along with dealer's invoice. Sales tax can be paid at your local tax collector. A copy of a notarized or witnessed bill of sale must accompany all applications, if boat is purchased from an individual. If this boat has been registered in your name in another state, provide a copy of that registration in lieu of a bill of sale. Must provide proof of last registered owner.
Applicant First Name |
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Date of Birth |
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Home Phone |
Other Phone |
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E-Mail |
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Mailing Address |
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State |
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Driver’s License # or Social Security # |
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D.L. State |
Previous Owner |
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Co-Owner First Name |
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Date of Birth |
Driver’s License # or Social Security # |
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ALL BOATS MUST HAVE A HULL
IDENTIFICATION OR SERIAL NUMBER.
If not, boat must be inspected. Please call your local Regional Office for additional information.
Serial Number or 12 Digit Hull I.D. #
* APPLICANT’S SIGNATURE REQUIRED *
SIGN HERE
Signature Certifies Ownership |
Date |
By signing this application, I declare under penalties prescribed in the statutes of Mississippi, to the best of my knowledge and belief that I own the vessel described herein and that the description and all matters stated herein are true and correct.
Present Registration # on Boat
HULL MATERIAL |
PRIMARY OPERATION |
PROPULSION |
FUEL TYPE |
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TYPE OF VESSEL |
Paddlecraft |
ENGINE DRIVE |
o Fiberglass |
o Pleasure |
o Air Thrust |
o Gasoline |
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o Open Motorboat |
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Inboard |
o Aluminum |
o Rent or Lease |
o Manual |
o Diesel |
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o Cabin Motorboat |
o |
Air Boat |
o |
Outboard |
o Wood |
o Commercial Fishing |
o Propeller |
o Electric |
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o Auxiliary Sail |
o |
Pontoon Boat |
o |
Pod Drive |
o Steel |
o Other Cml Operation |
o Sail |
o Other |
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o Sail Only |
o |
Inflatable Boat |
o |
Stern Drive |
o Plastic |
o Cml Passenger Carry |
o Water Jet |
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o Personal Watercraft |
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Rowboat |
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Other |
o Rubber/ |
o Dealer or Mfr Demo |
o Other |
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o House Boat |
o |
Other |
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Vinyl/Canvas |
o Agency |
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o Other |
o Charter Fishing |
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Saltwater Fishing: q Yes q No |
U.S. Citizenship: q Yes |
q No |
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OPTIONAL INFORMATION
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Motor Serial Number |
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Manufacturer |
Model Year |
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Horse Power |
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Motor Serial Number |
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Manufacturer |
Model Year |
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Horse Power |
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Make check or money order payable to MS Dept. of Wildlife, Fisheries, and Parks • Boat Registration Div.• 1505 Eastover Drive • Jackson, MS 39211-6374
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DETACH AND KEEP WITH VESSEL UNTIL CERTIFICATE NUMBER IS RECEIVED
Name ________________________________________________ |
Street Address ____________________________________________ City ________________________ |
State ___________________ Zip Code _____________________ |
HIN or Serial Number _____________________________________________________________ |
Make of Boat ______________________________________ Propulsion _________________________________________ Length of Boat ___________________________
I hereby certify on ______________________________ , that I applied for certification of number for above described boat.
Valid for 60 days of issue. Carry on board when the vessel is being operated.
UNDER PENALTY OF PERJURY THIS INFORMATION IS TRUE AND CORRECT. ______________________________________________________________ |
Revised 09/2016 |
Signature of Owner |
Date |
(OVER) |
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INSTRUCTIONS
1.Type or print in ink, except the signature.
2.Owner of boat must sign this application.
3.All shaded areas must be completed.
4.If vessel is presently numbered, enter number in space provided on front.
5.If vessel is registered in your name in another state, please send copy of registration from that state in lieu of a bill of sale.
All transfer and new boats are processed at MDWFP headquarters ONLY, address listed below.
Return Application with personal check, cashier’s check, or money order with the appropriate fee to the address listed below.
Mississippi Department of Wildlife, Fisheries, and Parks Boat
Registration Division
1505 Eastover Drive • Jackson, MS 39211-6374
FOR YOUR CONVENIENCE, YOU MAY USE THE AREA BELOW
AS A VALID BILL OF SALE WHEN PROPERLY WITNESSED OR NOTARIZED
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Serial Number or 12 Digit Hull ID # |
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Present Registration # |
Feet |
Inches |
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Make of Boat |
Boat Model |
Model Year |
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Buyer: (Print) |
________________ |
________________ |
________________ |
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Last Name |
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First Name |
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Initial |
Seller: (Print) |
________________ |
________________ |
________________ |
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Last Name |
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First Name |
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Initial |
Co-Seller: (Print) |
________________ |
________________ |
________________ |
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Last Name |
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First Name |
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Initial |
__________________________________ |
________________ |
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___________ |
Seller’s Street Address |
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City |
State |
Zip Code |
__________________________________ |
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________________________ _________ |
Seller Signature |
Date |
Co-Seller Signature |
Date |
__________________________________ |
______ |
________________________ _________ |
Buyer Signature |
Date |
Witness Signature |
Date |
SELLER(S) CERTIFY THAT STATEMENTS PROVIDED ON THE FRONT OF THIS APPLICATION FOR CERTIFICATION
OF REGISTRATION ARE TRUE AND ACCURATE TO THE BEST OF SELLER(S) KNOWLEDGE.
STATE OF: _______________________ |
COUNTY OF: _______________________ |
This day personally came and appeared before me, the undersigned stated that all of the matters, |
things and facts set forth are true and correct as therein stated. |
SWORN TO AND SUBSCRIBED BEFORE ME, this the ______________day of _____________, 20_____ |
____________________________________________ |
My Commission expires __________________ |
Notary Public |
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This Stub is to serve as your receipt until you receive your Certificate of Number. This must be kept with the vessel and available
for inspection by Law Enforcement Officers. Upon payment of fee this stub authorizes use of your vessel. Its validity may be verified at any time by Law Enforcement Officers. Make check or money order payable to the Mississippi Department of Wildlife,
Fisheries, and Parks. Record your check or money order number here ____________________________
Internet Boater Education Course • www.mdwfp.com • $15.00 (Online Fee)
Free 6-Hour Classroom Courses/Contact MDWFP Region Offices;Classes Available April-September
Call 1-888-874-5785 to Subscribe to Mississippi Outdoors Magazine. (this number is for magazine subscription only)
