Kentucky Transportation Cabinet
Division of Motor Vehicle Licensing
Motor Boat Transaction Record/Application for Registration and/or Title
TC 96-184
Rev: 5/2020
Page 1 of 2
KRS 186A.990 states: Any person who knowingly enters or attests to the entry of false or erroneous information upon this form will be subject to the penalties of forgery in the second degree; KRS 235.990 states: Any person who violates any of the provisions of this chapter or administrative regulations adopted under this chapter shall be fined not less than fifty dollars ($50) nor more than two hundred dollars ($200).
Check the type of application desired: 
Duplicate 
Update 
KY Transfer 
Out-of-State Transfer
First Time 
Salvage 
Rebuilt
Title Only
If Duplicate is checked, the original Certificate of Title is: |
Lost |
Destroyed |
Damaged |
Illegible |
Other |
PLEASE NOTE: THE ORIGINAL OF THIS FORM MUST BE COMPLETED IN BLUE OR BLACK INK.
Section 1: VESSEL IDENTIFICATION SECTION (See Reference Page for field values)
__________________________________________________________________________________________________________________________________________________
Previous Title NumberStateKY #Hull Identification (HIN)YearMakeModel
__________________________________________________________________________________________________________________________________________________
Primary Operation (Boat Use)Vessel TypeHULL MaterialEngine DrivePropulsionCounty of Dockage
__________________________________________________________________________________________________________________________________________________
FuelLength (feet, inches)Beam (feet, inches)Capacity or Weight Capacity# of Toilets Toilet Type
Section 2: VESSEL ENGINE/MOTOR
__________________________________________________________________________________________________________________________________________________
Motor 1 MakeYearHorse PowerMotor Serial #Year PurchasedPurchase Amount
__________________________________________________________________________________________________________________________________________________
Motor 2 MakeYearHorse PowerMotor Serial #Year PurchasedPurchase Amount
Section 3: VESSEL BRAND DISCLOSURE |
Rebuilt |
Salvage |
Hail Damage |
Water Damage |
Un-rebuildable |
Section 4: VESSEL LIEN INFORMATION |
|
|
|
|
|
I have I have not applied for a loan in connection with the motorboat described herein and if not, |
I will I will not apply for a loan within 30 days of this application. |
I warrant that the motorboat described above is not subject to an unterminated lien and that no loan in connection with this motorboat has nor will be applied for by seller within 30 days of this application.
______________________________________________________________ |
_______________________________________________________________ |
|
First Lienholder |
|
|
Lien County: |
|
Second Lienholder |
|
|
|
Lien County: |
______________________________________________________________ |
_______________________________________________________________ |
|
Address |
|
|
|
|
Address |
|
|
|
|
|
|
______________________________________________________________ |
_______________________________________________________________ |
|
City |
State |
Zip |
Phone # |
|
City |
|
State |
Zip |
Phone # |
|
|
|
|
|
|
|
Section 5: VESSELTRANSFEROR/SELLER SECTION |
|
VESSEL TRANSFEREE/OWNER/BUYER SECTION |
|
|
______________________________________________________________ |
________________________________________________________________ |
Name of Transferor/Seller |
|
|
Dealer Number |
Name of Transferee/Owner/Buyer |
|
|
DL/SSN/FED ID# |
|
|
|
|
|
BUYER JOINT OWNERSHIP: |
OR |
AND |
|
|
|
|
|
|
|
|
(NOTE: If neither box is checked, the transfer shall require both signatures.) |
______________________________________________________________ |
________________________________________________________________ |
Name of Second Transferor/Seller |
|
|
|
Name of Second Transferee/Owner/Buyer |
|
DL/SSN/FED ID# |
_______________________________________________________________________ |
_________________________________________________________________________ |
Mailing Address |
|
|
|
|
Mailing Address |
|
|
|
|
|
|
_______________________________________________________________________ |
_________________________________________________________________________ |
Home Address (if different from above) |
|
|
|
Home Address (if different from above) |
|
|
|
|
_______________________________________________________________________ |
_________________________________________________________________________ |
City |
County |
|
State |
Zip |
City |
County |
|
State |
Zip |
__________________________________________________ |
___________________________________________________ |
Email address |
|
|
Phone # (with area code) |
Citizenship of Primary Applicant |
|
|
Sex |
Date of Birth |
Vessel Sale Price _________________________________________________________ |
__________________________________________________________________________ |
________________________________________________________________________ |
Email address |
|
|
|
Phone # (with area code) |
_________________________________________________________________________ |
Transferor/Seller’s Signature |
|
|
|
|
Transferee/Owner/Buyer Signature |
|
|
|
|
________________________________________________________________________ |
__________________________________________________________________________ |
Transferor/Seller Signature |
|
|
My commission #: ________________ |
Transferee/Owner/Buyer Signature |
|
|
My commission #: |
_________________ |
|
|
|
|
|
|
|
|
|
Subscribed and attested before me on this date ____________. My commission expires ____________. |
Subscribed and attested before me on this date ____________. My commission expires ____________. |
Attesting Official/Notary Signature/Title________________________________________ |
Attesting Official/Notary Signature/Title______________________________________________________ |
Section 6: County Clerks Use Only
I certify that the lien indicated to be filed has been noted into the automated system and that a title will be withheld for 30 days, or until financing statement and fees required are received, whichever occurs first.
Clerk Signature: _____________________________________________County:__________________ Date: _______________________
DO NOT ACCEPT TITLE OR APPLICATION SHOWING ANY ERASURES, ALTERATION, OR MUTILATIONS.
Kentucky Transportation Cabinet
Division of Motor Vehicle Licensing
Motor Boat Transaction Record/Application for Registration and/or Title
TC 96-184
Rev: 5/2020
Page 2 of 2
Primary Operation |
Pleasure |
Commercial Fishing
Government Agency
Rent or Lease |
Charter Fishing |
Commercial Passenger |
Other Commercial Use |
Dealer or Manufacturer Demonstration
Make and Model |
Model Year |
HULL identification Number (HIN) |
|
Vessel Type
HULL Material
Air Boat
Houseboat
Personal Watercraft
Other-Hovercraft
Other
Aluminum
Wood
Other
Auxiliary Sail |
Cabin Motorboat |
Inflatable Boat w/ motor |
Open Motorboat |
Pontoon Boat |
Other-Commercial |
Other-Hydrofoil |
Other-Hydroplane |
Fiberglass |
Steel |
Plastic |
Rubber/Vinyl/canvas |

Inboard
Stern Drive
Diesel
Other
Title Number __________________________________________