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Form D-VH Shane sears concn orc i on none DUH 0265 ‘SATE OF REGETRATIONPUBLCATION we 03 om 29 vee 06 DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VHICOM) Please give the make and model of the vessel that embodies the design. Scout 222 Ab: TITLE 9 (1) Whats the type or syle ofthe design Tor which registration i sought? ‘ cabin ———— ([>) Provide bref general statement seting forth the salient features of the design. DESIGN Hull form, deck configuration, and overall appearanc Bonect nar fhisiee single —~ ——— ~~ esign, Dleheck nore SEGRE (his designs derive fom an earlier design, describe how tat design has en revise, adapted, or earange tte ror = a aa = binweon foeadstionat | nT SaansneEEEREEESSENEEET aa a Provide the name and address of the designes(s). The name ofthe employer may be given instead ofthe designer(s) if (1) the design was made within the regular scope of employment ofthe designers) and (2) the individual authorship of the design is dificult ‘ impossible to ascribe. DESIGNERS) 1 Please check here if those contitions are satisfied and you are providing the employe’ name. Name: Scout Boats, Tne. Name: Address: 2582 Hwy 78 West ‘Adldcess. Summerville, SC 29463 cent sctneneeemeranaannscnncaenNraNaRntsteNiT eR AeR Ens ICNSREN CSI | If the owner is different from the designer(s) or employer named above, provide the name and address of the owner: ‘Was an application for repirtion of hi eign esd (| Mes i ey coms of apa EX (21) nam application fled in a foreign county that extends 10 Lo] designs of owners who are citizen ofthe United States, or Pam erry 10 Petons fing aplication inthe United Sates, similar Date of application: ‘rotction to that afforded in 17 US.C. chapter 13? CLAIM Yes QNo Sevial Nox 5 Wests dsgn ar bli bee dof opin? Yes No TE ED — 08 as 2005 DESIGN COPIES RECEIVED. { Uyes,on what dater 0% 352005 fy bemomcoresrecae nize mane = or 7 E HaeOg 2006 ———————— BP harde 700s : in BR RR SSE HBS FA a ae it EXAMINED BY” FORM D-VH rECED BY Sonne FOR ee COPYRIGHT ayes OFFICE USE ony 0 NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VHVCOM) “Please provide the name and address of the person to whom correspondence regarding this application may be disected: Fame ate sui — : CONTACT agires: 258% Hey 70. Heat _ _ [37 Ghencomeinisscmtontride pint ahe aos Det Asn sein CO Samet Acme a a DEPOSIT Account number: ACCOUNT DECLARATION: The undersigned, as the applicant or the applicant’ duly appointed agent or representative, being bereby warmed that willful false statements are punishable by fine or imprisoament, or both, under 18 U.S.C. §1001, and that such willful false statements may jeopardize the validity of this application or any resulting registration, hereby declares tothe best of his orher knowledge and belief: (1) that the design has been fixed in a useful article; (2) that the design is original and was created by the designer(s), oc employer if applicable, named in the application: @) that those aspects ofthe 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 intitle: and (5) that the applicant isthe person entitled to protection and to registration under chapter 13 of tile 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 ofthe design notice: Protected Design Scout Boats 2006 CERTIFICATION AND SWORN STATEMENTS Where on the useful article isthe design notice located”? ‘Transom If the weclersigned is not the applicant, he or she is properly authorized to execute this application on behalf of the applicant. % __ _ canuaey 208, 2006 : "RES auntson Tehwtcial Sevigner aaa 375210068, (043.725.0082 Steve Potts 2561 Hwy 78 West | Sumerville, SC 29483 {7.USC. $1327. Penaty fr fetes rpremetation“Whawrt known a iresetsn ratory along Bw es nbs wi te cater re ape ocr sao SLigpnd ss a snp Poy et nr a Bond mean tO a an ge ogee Ps mah ay he Ge oe eC a ee ry 2000-4 Rar nary 2009, Pd on ye CR US corer Peng Otc 09