Advanced-elements AE1007 User Manual download pdf (Page 17)

Note: If your state requires the licensing of this boat, please use the form below. If you need any assistance filling

out this form, please contact Advanced Elements Customer Service Department.

MANUFACTURER’S STATEMENT OF ORIGIN

FOR A VESSEL SOLD IN THE STATE OF_____________________________________

The undersigned manufacturer hereby certies that the new boat described below, the property of

said manufacturer, has been transferred this _________day of _____________________, 20_________on

Invoice# _________________to:

Owner’s/Dealer’s Name_____________________________________________________________

Address___________________________________________________________________________

City, State, Zip______________________________________________________________________

Model Name Model Year Manufacturer’s Hull Identication#

m AdvancedFrame™ __________ HIN# _________________________

Convertible Kayak(AE1007)

Type: Kayak Hull Material: PVC/Polyester

Length Overall: 15’ Beam: 34”

U. S. Coast Guard Capacity Plate Information (where applicable):

Maximum persons capacity in whole persons: 500 lbs (227 kg)

Maximum weight capacity (persons & gear): 550 lbs (249 kg)

The manufacturer further certies that this was the rst transfer of such new boat and that all

information given herein is true and accurate to the best of their knowledge

P.O. Box 5128 Concord, CA 94524

Signature_________________________________________________________________________________

FIRST ASSIGNMENT

FOR VALUE RECEIVED, in the amount of $ __________________________________________________,

the undersigned hereby transfers the Certicate of Origin and the boat described therein

to _______________________________________________________________________________________

Address __________________________________________________________________________________

and certies that the boat is new and has not been registered in this or any other state; Advanced

Elements, Inc. also warrants the title of said boat at time of delivery, subject only to the liens and

encumbrances as set out below:

Amount of Lien Date To whom Due Address

___________________ __________ __________________ ___________________________________

Dates___________________________ 20 _________, at _____________________ ____________________

___________________________ By:___________________________________________________________

Transferrer (Firm name) Sign Here ___________________________________________________________

Before me personally appeared _____________________________ who by me being duty sworn under

oath says the statements set forth above are true and correct. Subscribed and sworn to me before

this __________ day of _____________________________ 20 ___________.

___________________________________Notary Public Date commission expires_______________

(SEAL)

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Advanced-elements AE1007 User Manual Page 17