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FORM D-VH For Vessel Hull Design UNITED STATES COPYRIGHT OFFICE. REGISTRATION NUMBER DUH 0215 Dive OF REGISTRATION PUBLICATION 04 a 05 Monn ow Yow <__00 NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VH/CON) 1 Please give the make and model of the vessel that embodies the design. WelleraR 252 Fisherman TITLE — 7) What is the type or style of the design for which registration is sought? (€) Fhorlass singe vu and sock Provide a brief general statement setting forth the salient features ofthe design. DESIGN’ (b) [Layout of the deck Including features integral with the deck Dhcneck nar this ie " SESE (c.)_ this design derived fom an cartier design, esrb how tht design has been revised dee, or rearanged, one design ul is Ose fom DSVHVGON {or adttional 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 regular scope of employment of the designer(s)and 2) theindividual authorship ofthe designs difficult ‘or impossible to ascribe, DESIGNER) © Please check here if those conditions are satisfied and you are providing the employer's name. Name: Welleraft Marine ‘Name: - ‘Address; 1851 Whitfield Avenue Address: ‘Sarasola, Forde 34243, Ifthe owner is different from the designer(s) or employer named above, provide the name and address ofthe owner: Name: OWNER, IFNOT anal DESIGNERS) in an application filed in a foreign country that extends to () Country designs of owners who are citizens ofthe United States, or to persons filing applications in the United States, si 5 (a) Wes snapper rpsraon of is ceagnideiied (fy Hes ently he county end dt of appesion Date of application: —__ PRIORITY = protection to that afforded in 17 U.S.C. chapter 13? CLAIM Dyes BNo Serial No; ‘Was this design mde oli befoe te date of apiton?@ Yes) No ff secon aeceED 6 Ifyes, on what date? 08% ___ 232008 fy esorconesneceneo_ NAL 3 2 PAE MADE EB runosnecsve AY 20 PUBLIC Ag nm sale tel pabae WORE ON BACK EXAMINED BY FORM D-VH CHECKED BY GO CORRESPONDENCE co ear ayes OFFICE USE ONLY DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET, (Form D-VWGON) ‘Please provide the name and address of the person to whom correspondence regarding this application may be directed 7 Name: Dvd G. Schmitz _ __ CONTACT agress; Merchant 8 Gould P.C., 3200 1DS Center. 80 South Elghth Steet. Mimteapolis, MN 55402 PERSON = — _ Email address .$8etmaltz@merchan-gould.com FAX number £12:392.9081 . Daytime phone: ( 612) 338.4617 Give the name and account number if the registration fee istobe charged to a Deposit Accountestablished in the Copyright Office: Name of Account: ___ —— = DEPOSIT Account number: ACCOUNT - — meee aneeccentemraetnsnearcene see no tear DECLARATION: The undersigned, as the applicant or the applicant's duly appointed agent or representative, being hereby wamed 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 bestofhisorher knowledge and belief: (1) that the design has been fixed in a useful article; (2) thatthe 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 pater (@) that the design has not previously been registered on behalf ofthe applicant or applicant's predecessor in tite; and (5) that 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: Protocted Design, Wellraft Marine 2003, the design notice located? CERTIFICATION AND SWORN STATEMENTS: ‘Sie David G. Schmalz _ Pa oriypa rare Poon oF 6123364617 612.392.9081