Sellers Vessel Disclosure

(Note: This document is provided as a guide only. You should consult your legal representative for Bill of Sale and other concerns. A similar form should be developed to cover any purchase of marine electronics and the trailer.)

I, ______, certify to the best of my knowledge, the following information regarding my ownership of this vessel, that is described as follows:

______/__

Year Make Model Hull Identification # Registration#/Year

______

Engine Year Engine Make Engine Model Horsepower Engine Serial #

______

Outdrive Year Outdrive Make Outdrive Model Outdrive Serial #

1. ( ) Has not, as a result of collision or grounding, sustained any hull damage.

( ) Has, sustained hull damage as a result of collision or grounding and is described:

______

2. ( ) Has not, as a result of flooding or sinking, sustained any damage.

( ) Has, sustained damage as a result of flooding or sinking and is described:

______

3. ( ) Has not, as a result of fire, sustained any damage.

( ) Has, sustained damage as a result of fire and is described as follows:

______

4. ( ) Has not, as a result of warranty claim, been repaired.

( ) Has been repaired as the result of a warranty claim and is described:

______

5. ( ) Has not, as a result of lightning, sustained any damage.

( ) Had sustained a lightning loss and is described: ______

6. ( ) Has not had any major propelling engine or generator problems or rebuilds. ( ) Has had major propelling engine and/or generator problems and/or rebuilds and is described as follows: ______

7. ( ) Has not had peeling, sand blasting or grinding out of osmotic blisters or coatings. ( ) Has had peel, sand blast or grind out of osmotic blisters and coatings:______

8. LEINS

( ) My vessel is not subject to any leins or assigned security interest.

( ) My vessel is subject to the following leins or has been listed as a security in the following loan(s).

______

First Leinholder or Security Interest and Name/Address Balance Due

______

Second Leinholder or Security Interest and Name/Address Balance Due

Signature of Owner: ______Date: ______

The above information was disclosed to the prospective buyer by the seller (prior owner) of the vessel ______and said information is acknowledged as having been disclosed and taken into account for in the agreed price on the above described vessel between seller and the prospective buyer.

Signature of Prospective Buyer ______Date: ______

Witness/Notary ______Seal.