"Application for Marine Dealer Certificate of Number" - Connecticut

Application for Marine Dealer Certificate of Number is a legal document that was released by the Connecticut Department of Energy and Environmental Protection - a government authority operating within Connecticut.

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Download "Application for Marine Dealer Certificate of Number" - Connecticut

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Connecticut Department of Energy &
APPLICATION FOR MARINE DEALER
CERTIFICATE OF NUMBER
Environmental Protection
Marine Dealer, Yacht Broker, Marine
Boating Division
Engine Manufacturer, OR
P.O. Box 280, 333 Ferry Road
Marine Surveyor
Old Lyme, CT 06371-0280
W: (860) 434-8638
REQUESTING:
New
Additional
Renewal
CT. Sales Tax Number:
Business Name:
Business Phone No.:
Business Address
:
City/Town:
State:
Zip Code:
(No. and Street)
Yacht Broker
Marine Engine Manufacturer
Marine Surveyor
Marine Dealer
Retail New
Retail Used
MFG
Repairs
Sales
Credentials Attached
MFG
Wholesale Distributor
QTY
Total
If renewing, list numbers to be renewed here
MDRNs
NEW
ADDL
$100
Number
Number
Number
RENEW
$100
Number
Number
Number
EXAMINATION FEE*
$140
Number
Number
TOTAL: Payable to "DEEP"
Notes:
(1) Marine Surveyors may be issued only CON/MDRN
(2) Yacht Brokers may apply for only one CON/MDRN in their first year
*First-time applicants only. Marine Surveyors do not pay this fee.
Name
Person Signing Below
(Last, First, M.I.)
Residence Address
City/Town
State
Zip Code
Marine Engine Manufacturer
Yacht Broker
Please complete the lower form and sign in the presence of a Notary
Marine Dealer
I declare that I am a Marine Dealer, Marine Engine Manufacturer, or Yacht Broker engaged in the business of manufacturing, selling or repairing new or
used vessels or of manufacturing, selling or repairing or marine engines and that I have an established place of business for the sale, trade, display or repair
of such vessels or repair of such engines, unless exempted by law from the requirement to have an established place of business. I have complied with the
requirements and criteria for the issuance of marine dealer registration numbers, and I agree to use and display marine dealer registration number(s) solely
as specified in the Connecticut General Statutes and the Regulations of the Connecticut State Agencies, as amended from time to time. I also declare under
the penalties for false statement provided in Connecticut General Statutes that the statements made herein by me are true and correct.
Authorized Signature
(Owner, Partner, Officer)
Sign in the presence of a Notary
Marine Suveryor
Attach Current Credentials Please complete the lower form and sign in the presence of a Notary
I declare that I am Marine Surveyor who is certified by the National Association of Marine Surveyors or accredited by the Society of Accredited Marine
Surveyors and that I am engaged in the business of inspection, survey or examination of vessels or associated equipment to assess, monitor, and report on
the condition of the vessel or associated equipment. I have complied with the requirements and criteria for the issuance of a marine dealer registration
number, and I agree to use and display the marine dealer registration number solely as specified in the Connecticut General Statutes and the Regulations of
Statutes that the statements made herein by me are true and correct.
Authorized Signature
(Certified Marine Surveyor)
Sign in the presence of a Notary
Date
Title
(all applicants)
(all applicants)
Owner's Date of Birth
( all applicants)
Citizenship
(all applicants)
Sworn Before
(Nortary Public, Justice of the Peach, Officer of the Court)
Connecticut Department of Energy &
APPLICATION FOR MARINE DEALER
CERTIFICATE OF NUMBER
Environmental Protection
Marine Dealer, Yacht Broker, Marine
Boating Division
Engine Manufacturer, OR
P.O. Box 280, 333 Ferry Road
Marine Surveyor
Old Lyme, CT 06371-0280
W: (860) 434-8638
REQUESTING:
New
Additional
Renewal
CT. Sales Tax Number:
Business Name:
Business Phone No.:
Business Address
:
City/Town:
State:
Zip Code:
(No. and Street)
Yacht Broker
Marine Engine Manufacturer
Marine Surveyor
Marine Dealer
Retail New
Retail Used
MFG
Repairs
Sales
Credentials Attached
MFG
Wholesale Distributor
QTY
Total
If renewing, list numbers to be renewed here
MDRNs
NEW
ADDL
$100
Number
Number
Number
RENEW
$100
Number
Number
Number
EXAMINATION FEE*
$140
Number
Number
TOTAL: Payable to "DEEP"
Notes:
(1) Marine Surveyors may be issued only CON/MDRN
(2) Yacht Brokers may apply for only one CON/MDRN in their first year
*First-time applicants only. Marine Surveyors do not pay this fee.
Name
Person Signing Below
(Last, First, M.I.)
Residence Address
City/Town
State
Zip Code
Marine Engine Manufacturer
Yacht Broker
Please complete the lower form and sign in the presence of a Notary
Marine Dealer
I declare that I am a Marine Dealer, Marine Engine Manufacturer, or Yacht Broker engaged in the business of manufacturing, selling or repairing new or
used vessels or of manufacturing, selling or repairing or marine engines and that I have an established place of business for the sale, trade, display or repair
of such vessels or repair of such engines, unless exempted by law from the requirement to have an established place of business. I have complied with the
requirements and criteria for the issuance of marine dealer registration numbers, and I agree to use and display marine dealer registration number(s) solely
as specified in the Connecticut General Statutes and the Regulations of the Connecticut State Agencies, as amended from time to time. I also declare under
the penalties for false statement provided in Connecticut General Statutes that the statements made herein by me are true and correct.
Authorized Signature
(Owner, Partner, Officer)
Sign in the presence of a Notary
Marine Suveryor
Attach Current Credentials Please complete the lower form and sign in the presence of a Notary
I declare that I am Marine Surveyor who is certified by the National Association of Marine Surveyors or accredited by the Society of Accredited Marine
Surveyors and that I am engaged in the business of inspection, survey or examination of vessels or associated equipment to assess, monitor, and report on
the condition of the vessel or associated equipment. I have complied with the requirements and criteria for the issuance of a marine dealer registration
number, and I agree to use and display the marine dealer registration number solely as specified in the Connecticut General Statutes and the Regulations of
Statutes that the statements made herein by me are true and correct.
Authorized Signature
(Certified Marine Surveyor)
Sign in the presence of a Notary
Date
Title
(all applicants)
(all applicants)
Owner's Date of Birth
( all applicants)
Citizenship
(all applicants)
Sworn Before
(Nortary Public, Justice of the Peach, Officer of the Court)
APPLICATION FOR A MARINE DEALER CERTIFICATE OF NUMBER and MARINE DEALER REGISTRATION NUMBERS
Marine Dealer Registration Numbers (MDRNs) are portable vessel registration numbers that allow a Marine Dealer to operate an
unregistered vessel on the waters of the state. They consist of two parts: a Certificate of Number (CON) issued by DEEP and identifying a
unique Marine Dealer Registration Number, and portable placards constructed by the applicant that bear their unique MDRN.
MARINE DEALERS, YACHT BROKERS, MARINE ENGINE MANUFACTURERS
PREREQUISITES TO RECEIVING MARINE MDRNS (SEE CGS SECTION 15-145 AND RCSA SECTION 15-121-B5)
1. The applicant must have an established place of business facility with at least 144 square feet of office space, plus on-site or remote vessel
display space, and must be open to the public.
2. There must be signage of at least 250 square inches identifying the business facility and visible to the public.
3. There must be a phone number in the business name listed with the phone company.
4. The applicant must maintain a records retention system to allow retention and inspection of sales records for at least four years.
5. The applicant must apply on this DEEP form, and must sign the form attesting to the fact that these conditions have been met.
6. YACHT BROKERS ONLY - Items No. 1 and No. 2 do not apply. Yacht Brokers are required to display on any vessel that bears the broker's MDRN a
"For Sale By Broker" sign identifying the broker. The sign must be at least 144 square inches in size and legible from not less than fifty feet.
PREREQUISITES TO RENEWING MDRNS (SEE CGS SECTION 15-145 AND RCSA SECTION 15-121-B5)
The Commissioner may renew a MDRN if satisfied that the Marine Dealer continues to meet the prerequisites for receiving MDRNs and at
least one of the following criteria during the year prior to the application for renewal:
1. Manufacturer or sale of more than five vessels required to be numbered or registered;
2. Manufacturer or sale of two to five vessels required to be numbered or registered pursuant to Section 15-152 of the general
statutes, of not less than $50,000 total gross value where the gross value credited by any vessel towards the $50,000 minimum is no more
than $25,000;
3. Not less than fifty percent of the adjusted gross income of a Marine Dealer is derived from vessel sales;
4. The manufacturer, sale or repair of more than five marine engines by a Marine Engine Manufacturer.
MARINE SURVEYORS
Marine Surveyors may apply for and be issued one restricted-use CON/MDRN. Evidence of current certification or accreditation must be
presented at the time of initial application and when renewing. Marine Surveyors should note that certain recordkeeping requirements
apply uniquely to Marine Surveyors. A Marine Surveyor may not loan a CON/MDRN, and may only operate a vessel with their CON/MDRN
while the vessel is being inspected, surveyed or examined, and only when a written contract for such work is carried onboard.
ALL APPLICANTS
INSTRUCTION FOR PREPARATION OF APPLICATION
Please type or print application. This application may be used to order a CON/MDRN for the first time, renew a CON/MDRN, or request
additional CON/MDRNs. Please check the appropriate box at the top of the form accordingly.
1. Business name and address - These will be printed on certificate(s).
2. Connecticut sales tax no. - Number under which sales tax collected on vessels will be submitted.
3. Select ONE of the Marine Dealer/Marine Engine Manufacturer/Yacht Broker/Marine Surveyor options.
4. Enter the quantity of new or additional certificates requested in the boxes provided and multiply these numbers by the $100.00
fee. All first-time applicants (except Marine Surveyors) must include a $140.00 examination fee. Existing Marine Dealers that have
changed ownership or business name must reapply as a first-time applicant. All fees are to be made payable to "DEEP".
5. Name of Owner, Partner, or Authorized Officer signing application - The name of the individual signing the application Must
appear here. RESIDENCE ADDRESS IS REQUIRED. For corporate officers also give titles.
6. Signature and title - DO NOT TYPE. An applicant must sign his/her usual signature. An officer must sign for a firm, company or
corporation and indicate his/her title. This application is an oath-hearing form and MUST BE NOTARIZED.
REQUIREMENTS FOR DISPLAYING MDRNS (SEE RCSA SECTIONS 15-121-B4 AND 15-121-B5A)
MDRNs must be painted on or attached to a removable sign, and displayed in a manner similar to other registered vessels. The MDRN sign
must be temporarily attached to the vessel. If such a temporary display is unsafe or impracticable, the dealer may request the
Commissioner's approval of an alternative way to display the numbers. Whenever a MDRN is displayed on a vessel that is on the water, the
operator must carry the CON.
All applicants are responsible for knowing the laws and regulations applicable to their MDRN/Certificate of Number. See:
Connecticut General Statutes (CGS) Section 15-145: Marine dealer's, marine engine manufacturer's and marine surveyor's registration
numbers. Regulations. Fees. Availability and renewaal of certificates. Use of vessels. Restrictions.
Regulations of the Connecticut State Agencies (RCSA) Sec. 15-121-B4 Display of a number and validation decal, Sec. 15-121-B5
Criteria for the issuance of marine dealer registration numbers, Sec. 15-121-B5a Marine dealer registration numbers: application and
display.
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