Fillable Printable Boat Bill of Sale Form - Mississippi
Fillable Printable Boat Bill of Sale Form - Mississippi
Boat Bill of Sale Form - Mississippi
FORM PROVIDED BELOW IS A VALID BILL OF SALE WHEN PROPERLY WITNESSED OR NOTARIZED
Buyer: (Print) _________________________ _____________________ ___________
Last Name First Name Initial
Seller: (Print) _________________________ _____________________ ___________
Last Name First Name Initial
Co-Seller: (Print) ______________________ _____________________ ___________
Last Name First Name Initial
____________________________________ _____________________ ____ ___________
Seller’s Street Address City State Zip Code
___________________________ _______ ____________________________ ________
Seller Signature Date Co-Seller Signature Date
___________________________ _______ ____________________________ ________
Witness Signature Date Witness Signature Date
IF WITNESSED DOES NOT HAVE TO BE NOTARIZED.
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
INSTRUCTIONS
1. Type or print in ink, except the signature.
2. Owner of boat must sign this application.
3. All blanks MUST be completed with the following exceptions:
a. Rental boats need not indicate propulsion, fuel and horsepower unless the engine is rented as part of the boat.
b. Dealer’s do not complete boat identification. One registration number is assigned per dealer.
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.
Return Application with check or money order with the appropriate fee to :
Mississippi Department of Wildlife, Fisheries & Parks
Boat Registration Division
1505 Eastover Drive • Jackson, MS 39211-6374
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 Enforcement Officers.
Make check payable to the Department of Wildlife, Fisheries & Parks. Record your check or money order number here________________
SUBSCRIBE TO MISSISSIPPI OUTDOORS MAGAZINE : 1-888-874-5785
1 YEAR $6 / 2 YEARS $11
Make of Boat Year Built Hull # MI # Length
DETACH AND KEEP WITH VESSEL UNTIL CERTIFICATE OF NUMBER IS RECEIVED
MI# _____________________________
Name ____________________________________ Address _________________________________________________
City _____________________________________ State _____________________________ Zip Code ______________
Make of Boat ______________________________ HIN or SERIAL # __________________________________________
I Hereby Certify on _________________________ I made application for certification of number for above described boat.
____________________________________________
Signature of Owner
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.
REGISTRATION
VALID FOR THREE (3) YEARS
FOR OFFICE USE
FOR OFFICE USE
DATE
RCVD. _________
CK $___________
CK #___________
MO $__________
MO #__________
CASH $_________ RETURN
DATE__________
RCVD.
DATE _________
Revised 6/06
PRESENT REGISTRATION NO. ON BOAT
MISSISSIPPI MOTOR BOAT
REGISTRATION APPLICATION
FOR FASTER SERVICE RENEW AT:
• At any license agent location • Call
1-800-5GO-HUNT 24
hours a day •
• Online at www.mdwfp.com •
CHECK ONE
❒ New Application
❒ Transfer
❒ Renewal
Co-Owner
❒ Yes ❒ No
NEW APPLICATION TRANSFER RENEWAL
Less than 16 feet ...................... $9.20 ................. $9.20 ...............$9.20
16 to less than 26 .................... $24.20 ................$24.20 ............. $24.20
26 feet to less than 40 .............. $46.70 ................$46.70 ............. $46.70
40 feet and over ...................... $46.70 ................$46.70 ............. $46.70
Dealer number ....................... $39.20 ................$39.20 ............. $39.20
Duplicate ................................ $6.70 ................. $6.70 ...............$6.70
• ALL SHADED AREAS MUST BE COMPLETED •
First Name Middle Last
Street or Post Office Box City State Zip Code County
Date of Birth Driver’s License # Social Security # Home Phone #
Work Phone # Other Phone # Previous Owner U.S. Citizen
❒ YES ❒ NO
• ALL BOATS MUST HAVE A HULL IDENTIFICATION OR SERIAL NUMBER •
Boats Built Prior To Nov. 1, 1972 MUST Give Serial Number: Boats Built After Nov. 1, 1972 MUST Give 12 DIGIT Hull ID Number:
Length
Feet Inches Year Boat Built Make of Boat
HULL MATERIAL
1. ❒ Fiberglass
2. ❒ Aluminum
3. ❒ Wood
4. ❒ Steel
5. ❒ Other
6. ❒ Inflatable
BOAT USE
1. ❒ Personal Pleasure
2. ❒ Rental/Lease
3. ❒
Commercial Fishing
4. ❒ Other
5. ❒
Commercial Pleasure
6. ❒ Dealer
7. ❒ Agency
PROPULSION
1. ❒ Outboard
2. ❒ Inboard/Outboard
3. ❒ Inboard
4. ❒ Other
5. ❒ Sail
6. ❒ Jet
FUEL TYPE
1. ❒ Gasoline
2. ❒ Diesel
3. ❒ Other
4. ❒ Electric
TYPE OF BOAT
1. ❒ Open
2. ❒ Cabin Powered
3. ❒ Auxiliary Sail
4. ❒ Sail Boat
5. ❒ Jet Boat
6. ❒ Canoe
7. ❒ Kayak
8. ❒ House Boat
9. ❒ Paddle Boat
10. ❒ Air Boat
11. ❒ Other
12. ❒
Personal Watercraft
13. ❒
Pontoon
Saltwater Fishing (For Survey Purposes Only): ❒ Yes ❒ No
Co-Owner
First Name Middle Initial Last Name Date of Birth Social Security or DL Number
• OPTIONAL • • MOTOR & TRAILER INFORMATION • • OPTIONAL •
Motor 1 (Serial Number) Motor 1 (Manufacturer) Horse Power Motor 2 (Serial Number) Motor 2 (Manufacturer) Horse Power
Trailer Serial Number
• SIGNATURE REQUIRED •
Internet Boater Education Course • www.mdwfp.com • $15.00
FREE 6-Hour Classroom Courses / Contact MDWFP District Offices
Classes Available April - September
Signature Certifies Ownership Date
NOTICE: Proof of Mississippi Sales Tax to accompany all new and used boats bought from dealer. A copy of a valid bill of sale must accompany all applications. If this boat has been
registered in your name in another state, please send a copy of that form in lieu of a bill of sale.
• NOTE: BILL OF SALE IS REQUIRED •
