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FORM D-VH For Vessel Hull Design UNITED STATES COPYRIGHT OFFICE. [REGISTRATION NUMBER DVH 0058 ‘DATE OF REGISTRATIONPUBLICATION May 22, 2001 Mth bay Yew DO NOT WRITE ABOVE THIS LINE. IF YOU NEED NORE SPACE, USE A SEPARATE CONTINUATION SHEET, (Form D-VHICON) Please give the make and model of the vessel that embodies the design. Champion Boats 196 (a) aR SIREIne se ofthe dein for which reparation sought? A) pase boat hull. (b) Prove a bet geno itencat etng forth the alien eres of he deen tmeing (cc) iis desig s derived fom an cacti design, desrte how that design as Ben revised, adapted or rearrange ‘The design is loosely based on the Champion Boats 193 design but with increased dimensions. The tne design. Skweon wing walle wore moved ond the runing surface, hook placement, and turning rudder geometry were foradsiionsl — ~Gaveloped new. ~ Provide the name and address ofthe designer(s). The name of the employer may be given instead of the designer(s) if, (1) the design was made within the regular scope of employment ofthe designer(s) and (2)the individual authorship ofthedesignis difficult ‘or impossible to ascribe. DESIGNERS) 2 Please check her if those conditions ae satisfied and you ae providing the employer's name Name: _Chanpion Boats, Inc. Name: Address: 1815 Highway 201, South Sour 1 ‘Address: - Mountain Home, AR 72653 Tf the owner is different from the designer() or employer named above, provide the name and adress ofthe owner Name: OWNER, IFNOT Address: DESIGNERS) ‘Was an application for registration of this design identified (b) If yes, identify the country and date of application: (a) in an application filed in a foreign country that extends to ‘Country: —— designs of owners who are citizens of the United States, or to persons filing applications in the United States, similar Date of application: — FRIOKIEY) protection to that afforded in 17 U.S.C. chapter 13? euane Des QNo Serial No: ‘Was this design made public before the date of application? @ Yes Cl No [@ APPLICATION RECENED DATE MADE — APR 27 2001 PUBLIC MORE ON BACK * Deleted by CO per authority granted by Matthew pment A. Rosenberg in conversation May 11, 2001. ane. rz FORM D-VH oHEcKED EY ENCE For rhree ‘OFFICE Use ony DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form DVIUCON) 7 Please provide the name and address of the person to whom correspondence regarding this application may be directed: ‘Name: ___Matthew A. Rosenberg, Esq. Bitmonfeld, Kaplan & Sandweiss, PCy CONTACT dares: __168 North Meranes Avenue, Suite 400 PERSON St. Louis, MO_ 63105 E-mail mar@oks-Lew.com FAX mumber_(314) 863-9398. Daytime phone: (314 863-0800 a Give the name and account number ifthe registration fee istobe chargedto a Deposit Accountesiablished in the Copyright Office: ‘Name of Account: that willful false statements are punishable by fine or imprisonment, or both, under 18 U.S.C. §1001, and that such wilful false Stxemens may jeopardize the validity ofthis epplieatin or any resnking regiseation hereby dechrsto thebestof vet knowledge (A) that the design has been fixed ina useful article; (@) that the design is original and was created by the designer(s), or employer if applicable, named in the application; (G) that those aspects of the design for which registration is sought are not protected by a design patent; 4) that the design has not previously been registered on behalf of the applicant or applicant's predecessor in ttle; and 5) hat the applicant isthe person entitled to protection and to registration under chapter 13 of title 17, United States Code, Complete if applicable: The design has been made public with a design notice as prescribed by 17 U.S.C. §1306. Following is the exact form of the design notice: © Chenpion Boats, Inc. 2000 ‘Where on the useful article is the design notice located? Innediately below the Hull Identification Nunber Ifthe undersigned is not the applicant, he/she is properly authorized to execute this application on behalf ofthe applicant. Ceara ee 9 ‘DECLARATION: The undersigned, as the applicant or the applicant's duly appointed agent or representative, being hereby warned CERTIFICATION AND SWORN STATEMENTS Oy sors 24, 2001 ~ a Matthew A. Rosenbena "attorney for Claimant Fao = Fai Ta 314) 865-0800 (314) 865-9388 ‘maréoks-law.com FA ear Ena acess PE ees tp: Ue ade a ae ae ait + certificate — te Motthew A. Rosenberg, Esq. Geruiicate | ==" Blumenfeld, Kaplan & Sendwoiss, P.O wl be 168 North Merenec Avenue, Suite 400 malledin | oasaaaew reine St. Louis, M0_65105 Seaieas DYE 0058