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FORM D-VH For Vessol Hull Design UNITED STATES COPYRIGHT OFFICE REGISTRATION NUMBER DUH 0174 ‘DATE OF REGISTRATION/PUBLIGATION wontm 01 ony 23 vow OF DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VH/CON) 1 ‘Pease give the make and model of the vessel that embodies he design. Ranger 621 Fisherman TITLE —— ~ - —— wy) What isthe type or sigie of he dengn for whch epistaion ie sovgn? (a) Teng boot (bb) Bove bie gene statement seting fort the salen eaures of ie design DESIGN Deck eyout and overt hull configuration including sake tnes nd depth of Pull Baonect nero it this fea lng ‘sian. If this design is derived from an earlier design, describe how that design has been revised, edapted, or rearranged. “This design was derived from the Ranger 210 Reata. The 621 Fisherman has diferent stake lines a cferent dept, bsvuieo diferent ster and a diferent dock layout for additional estans, Provide the name and address of the designer(s). The name of the employer may be given instead of the designer(s) if, (1) the «design was made within the regularscope of employment of the designer(s) and (2) the individual authorship of the design is difficult ‘or impossible to ascribe, DESIGNER(S) © Please check here if those conditions are satisfied and you are providing the employer's name. Name: Wood Manufacturing Company, ne. Name: ‘Address: P.0-80x 178 Address:__ Highway 178 Noch Flippin, Arkansas 72694 Ifthe owner is different from the designer(s) or employer named above, provide the name and address of the owner: Name: ‘OWNER, IF NOT ‘Address: DESIGNERS) _— ‘Was an application for registration of this design identified (b) If yes, identify the country and date of application: (€) in an application fled ina foreign country that extends to (D) Country: designs of owners who are citizens of the United States, or ‘to persons filing applications in the United States, similar Date of application: PRIORITY protection to that afforded in 17 U.S.C. chapter 137 CLAIM Qyes BNo —— a ‘Was this design made public before the date of application? © Yes CQ No [fs APPL Ifyes, on what date? 29 fg oso cones secre WOv-2 + 2003 58 cunos neceiveo eg ooneceven —__NOV-p-+2893— rine pepe DATE MADE PUBLIC MORE ON BACK Eo nd nsiuaiee re San te orn a Sacion 8 Pope tol pages EXAMINED BY TE FORM D-VH GHECKED BY i FOR CORRESPONDENCE Pa Yes OFFICE —omnm “USE ‘OnLy DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET, (Form D-VI/CON) 7 Please provide the name and address of the person to whom correspondence regarding this application may be directed CONTACT aacress: Merchant & Gould PC, 3200 DS Center, 80 South Eighth Sire PERSON — a an 8 DEPOSIT Account number: ACCOUNT 9 Name: David G. Schmat — Email address 612.332.9081 FAX number Daytime phone: ( 612) 336.4617 Give the name and account number ifthe registration fee isto be charged toaDeposit Account established in the Copyright Office: Name of Account; ___ DECLARATION: The undersigned, asthe applicant or the applicant's duly appointed agent or representative, being hereby warned that willful false statements are punishable by fine or imprisonment, or both, under 18 U.S.C. §1001, and that such willful false statements may jeopardize the validity of this application orany resulting registration, hereby declares tothe best of his or her knowledge nd belief: (1) that the design has been fixed in a useful article; (@) that the design is original and was created by the designer(s), or employer if applicable, named in the application; (3) that those aspects of the design for which registration is sought are not protected by a design patent; (4) thatthe design has not previously been registered on behalf of the applicant or applicant’ predecessor in ttle; and (5) thatthe applicant isthe person entitled to protection and to registration under chapter 13 of ttle 17, United States Code, Complete if applicable: ‘The design has been made public with a design notice as prescribed by 17 US.C. $1306, Following is the exact form of the design notice: Protected Design, Rangor Boats, 2002 _ Where on the useful article is the design notice located? CERTIFICATION AND SWORN STATEMENTS Transom Sonat David G. Sehmate 612332.9081 Aschmaliz@merchantgould.com Contiticate Samay will be railed in | David G. Schmatz window Rinoscaveanar - envelope rae Merchant & Gould P.C., 3200 IDS Center, 80 South Eighth Street address: | | Sian aaa Minneapolis, Minnesota 55402 Sai ves ate sa ay apna ones tan 0 ar eos a O00. a any as repeat nm ae nb Stan net Ps pera anes © Preteen seeysespacer hy aecog he igs tari une’ ne rap’ rs pape soar peanen ee 1S Govamean rang On 200-461-1120