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Form D-VH ‘or nl tll Dogs DVH 0198 DATE OF REGISTRATIONPUBLIGATION 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 mode! of the vessel that embodies the design. CROWNLINE _275CCR TITLE 4) What is the type or style of the design for which registration is sought? 2 (a) PrpeRctass Cuppy’ cabin (b) Provide bref genera statement sein forth the salient fetes ofthe design aE OVERALL APPEARANCE INCLUDING DECK LAYOUT, HULL CONFIGURATION AND SHAPE Creek nore BERTIE (c) iis designs derived from an eater design, desi how ht sign as been revised, alapted, orange Ste form” BSvHeON for agonal 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 of the designis difficult ‘or impossible to ascribe. DESIGNERS) © Please check here if those conditions are satisfied and you are providing the employer's name. Name: CROWNLINE ROATS, INC. Name: ‘Address:_11884 COUNTRY CLUB ROAD Address: WEST FRANKFORT, IL 62896 If the owner is different from the designer(s) or employer named above, provide the name and address of the owner: Name: OWNER, : IF NOT ss DESIGNERS) Wasanepplleaionorregisraton of tis design ieifed (fy ME yes dey te country and date of pplication (2). inan application filed ina 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: PRIORITY protection to that afforded in 17 U.S.C. chapter 137 are O Yes KINO Serial No: ‘Was this design made public before the date of application? & Yes Q) No gy AbPuucAT EE JUL0 1.200% Ifyes, on what date? MAY __17_ 004 ven a ver "aL 1 2 DATE MADE PUBLIC MORE ON BACK Pope tol pegee eran em NP RS EOE EXAMINED BY. FORM D-VH CHECKED BY ] — COMESPONDENGE FOR CORRESPONDENCE ae ayes OFFICE USE, ONLY DO NOT WRITE ABOVE THIS LINE. IE YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SUEET. (Form D.VWGON)_____ ‘Please provide the name and address of the person to whom correspondence regarding this application may be directed: / Name: JAMES T. CLAXTON _ CONTACT quress: 11884 COUNTRY CLUB ROAD — ~ WEST FRANKFORT, IL 62896 Email address TCLAXTON@CROWNLINE.. COM FAX number 618-932-8746 _________________ Daytime phone: 18) 937-6426 _ Give the name and account number the registration fee isto be charged to a Deposit Account established in the Copyright Office: Name of Account: _ DEPOSIT Account number: ACCOUNT DECLARATION: The undersigned, asthe applicant or the applicant's duly appointed agent or representative, being hereby warmed that willful false statements are punishable by fine or imprisonment, ot both, under 18 U.S.C. §1001, and that such willful false statements may jeopardize the validity of this application or any resultingregistration, hereby declares tothe best of hisorher knowledge and belief: (() that the design has been fixed in a useful article; (2) 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) that the design has not previously been registered on behalf ofthe applicant or applicant’s predecessor intitle; and (5) that the applicant i the 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: ADHESIVE LABEL WITH "PROTECTED DESIGN" 2004 CROWNLINE BOATS, INC. ‘Where on the useful article is the design notice located? PORT AFT EXTERIOR CERTIFICATION AND SWORN STATEMENTS Ifth indersigned is nqt* cant. he or she is rovetly authorized to execute this application on behalf ofthe applicant. C JAMES T. GLAXTON PRESIDENT int orype name Paaon a Ts —— = 7h 18).,937-6426 __(618) 932-8746 __ ‘TCLAXTON@CROWNLINE . COM “Fatphsne sr FRR bet al as Copyright Office fees are subject to change. For current fees, check the Copyright Office websi write the Copyright Office, or call (202) 707-3000. Bes acces Certificate Rana’ will be maiedin | CROWNLINE BOATS, INC. ATTN: JAMES T. CLAXTON _ fa ou | Riecnnee FRESE nncncneterney are roms” | 11884 COUNTRY CLUB ROAD = Begins oom oddress: | Sasa WEST FRANKFORT, IL 626: Issn, 200041909 T7US.€ gr027Penay forts opreneniaion Vinee row) have prpon of cnrng ragarsoon desig nda is hate sl ays ray otis han 200 ae nt or tan 260, a any er pepes nu nail ny haven dsp unde shaper sabe ened” sur 2003 Web Rev: January 2003. @ Pied on xd paper 1S coverment Pritng OMe: 2009.0 DUH 0198