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DVH 0183 BATE OF REGISTRATONFUBLIGATION vee 925g OF, OF DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VH/CON) Please give the make and model of the vessel that embodies the design. ISLAND PACKET 370 TITLE, = SEE SRE rece (oy RRS a a fide a brief, ting forth the salient features of the design. pesion(D) PEE MAE HULL: SHARE “TOU RDCE SOIC KEEL, TRANSOM Geneamees CONFIGURATION, GENGRAL DECK SHAPE. CALINIT OP ROSS Sen" DESIGN , 2 Qieneck nore it registering: ) "this desig is defied from an earlier design, describe how that design has been revised, adapted, or rearanged. more than ( cone denign.* Provide the name and address of the designer(s). The name of the employer may be given instead of the designer(s) if, (I)the a design was made within the regular scope of employment ofthe designer(s) and (2) the ipdividual authorship of the design is difficult ‘or impossible to ascribe. DESIGNERS) I Please check here if those conditions are satisfied and you are providing the employer's name. Name: ROBERT K. JOHNSON NA, Name: Address: SCAND PACKET YACHTS padres 1479 WILD ACRES RD, LARGO, Fl. 33771 Al {If the owner is different from the designer(s) or employer named above, provide the name and address ofthe owner ‘ech Name: 0A, OWNER, . IF NOT Address: DESIGNERS) a (b) the country and date of appl Sey in an application filed in a foreign country that extends to Country: _ se designs of owners who are citizens ofthe United States, or is to persons filing applications in the United States, similar Date of application: PRIORITY protection i that afforded in 17 U.S.C. chapter 13? CLAIM O Yes No Serial No: ch ‘Was this design made public before the date of application?’ Yes (1 No ffs; APPUCATION RECEIVED. 3 ityes.on what dae? SEPT. I, 2003 DATE MADE pf enosreceneo FC 2 4 2003 PUBLIC MORE ON BACK 7 fergie apeiate toe eta eLia eee ee cea EXAMINED BY. FORM D-VHt wea GORRESPONDERCE ror CORRESPONDENCE con nove aves OFFICE USE only : NEED MORE SPACE, USE A SEPARATE COMTNUATION SHEET (Comm D-W7COR) catly “Please provide | the ‘name and address of the Person to whom correspondence regarding this apy ition may be directed: { Name, JERRY SWARTZ CONTACT ages: Se ISLAND PACKET YACHTS 1974 WILD ACRES RD. LARGO, Fl. 33771 Email adaress ferry @ ip vy. cou FAX number _?27> 530-5806 Daytime phone: (727 )_£3I-2365 "305 _ Give the name and account number if the registration fee is to be charged to a Deposit Account established in the Copyright Office: DEPOSIT Account number: ACCOUNT gy DECLARATION: The undersigned, as the applicant or the applicant's duly appointed agent or representative, being hereby wamed ea that willful false statements are punishable by fine or imprisonment, or both, under 18 U.S.C. §1001, and that such willful false ay statements may jeopardize the validity of this application or any resulting registration, hereby declares tothe best ofhis or herknowledge and belief: (Uthat 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 applicat G) that those aspects of the design for which registration is sought are not protected by a design patent; (G) that the design has not previously been registered on behalf of the applicant or applicant's predecessor intitle; and (5) thatthe applicant is the 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 U.S.C. $1306. Following is the exact form of the design notice: THE ISLUND PACKET 310 1S A PROTECTED DESIGN OWNED BY _ISLIWD PACKILT YRCHTS ACCORDING TO REGISTRATION WITH THE US COPYRIGHT OFEIKKE COMMENCING IN THE YEAR. 200% Where on the useful article is the design notice located? BELOW COMPRVIONWAY CERTIFICATION AND SWORN STATEMENTS Ifthe und: __« not the applicant, he or she is properly authorized to execute this application on Dy : = ‘PF EARL BLACKWELL FETS 3E-6431 72°7-5 30-5806 _ Fa Centiteste [fag ee Thateain | (SLPAVD PACICET YACHTS ATTN? JERRY SWARTZ. window NonbecSieaat oo KY 1174 WILD ACRES RD. LARGO, FL. 33771 17... $127. Porat on presentation. ‘Wowetnonngy man 9 We pvr aera acing ee coaraDe ser he ape or fe pone coat Sig nudrin on’ sanyo fay oa onan 80 sre mo ban 1 60a any so pga at wc ay hv bw Sg ne i ple’ hale ee™ Fev Je 2002-20000 Wb Ra rury2003 Preteen secy pape US Covert Pg OMe 00040-11920 001 DUH 0183