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Form D-VH Dhureo ses conmicht oct FEGISTEATION NUMGE ‘DVH 0280 ATE OF REGISTRATIONPUBLICATION | worn 04 oxy 03 vou 06 00 NOT WRITE ABOVE THI LINE. F YOU NEED NORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Farm D-VHICON) 4 "please giveth make and model ofthe vessel hatombodies he deign. SS i Van Dusen Mohawk 85 _ 7 - TITLE | ~ — x : — 2) 7 DESIGN: ing forth the salient features of the design, ; ” ‘Macachon and Liat water oe rg Ea ak foc Gewese. Adler desided + pot se rules Jone bret ‘eomerna'/”, if this design is derived from an earlier design, describe how that design has been revised, adapted, or rearranged. See rorn binucon feresina = 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) the individual authorship of the design is difficult or impossible to ascribe, 2 Please check here if those conditions are satisfied and you are providing the employer's name. Name: Edwavd S. Van Dusew — Name: _ Address: BAY Baler Avenus Ades: _ _ —Comcovd MP O\74 2 ——— 4 If tie owner is different from the designer(s) or employer named above, provide the name and address of the owner: ¢ Nane: COM posi emmg, Tne. OWNER, AER Baler Avenue IFNOT ee : — pa Concord » MA O\TA2 ‘Was an application for registration ofthis design identified |, Uf yes, identify the country and date of spplication: is, in an application filed ina foreign county that extends to” Country: — Fe 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 13? CLAM — Yes SENo Serial No: _—___ sts dso pi be ed of apa Yor Naf SrucmonazeneoSEP 0 92005 7 4 itves ona de? Se is 2093 | ses coossncenoSeP 08 2005 DATE MADE Be FUNDS RECEIVED - PUBLIC 5 can unin 7 ott i fi Bde 0 Wo wa MORE ON BACK ; orp apa eon econ vapid EXAMINED BY FORM D-VH CHECKED BY — FOR ‘CORRESPONDENCE COPYRIGHT ave ‘OFFICE USE ‘ONLY DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VHICON) Please provide the name and address of the person to whom correspondence regarding this application may be directed: Name: Edwavd Van Dusen a — CONTACT ss CONTACT dciess: _2EH Baker Avenue Concord MV OvT42. __ Emait address EVO ndusen @ netzqo. WE FAX number 4 1-369 - Bi bo2 Daytime phone: (7B) SFL~BIZ2%2F Give the name and account number the registration feito be charged toa Deposit Account established in the Copyright Ofc: ‘Name of Account: — — DEPOSIT Account number: ACCOUNT ~ — DECLARATION: The undersigned, asthe applicant othe applicants 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 ofthis application any resulting registration, hereby declares tothe best ofhisotherknowledge and belief (1) that the design has been fixed ina useful articles (2) that the design is orginal and was created by the designer(s), or employer if applicable, named in the application; {G) that those aspects of the design for which registration is sought are not protected by a design patent; (G) thatthe design has not previously been registered on behalf of the applicant or applicant's predecessor in tile; and (5) thatthe applicants the person entitled to protection and to registration under chapter 13 of ile 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: CIG2\xxx¥203 ‘Where on the useful article is the design notice located? Stovboad Stenn dick awd Seat plottorm If the uitdersigned is not the applicnnt he or she is properly authorized to execute this application on behalf of the applicant. TIFICATION AND é Zz g 2 a g = B z ° = a & Edword S. You Dusen 831-2132. 9]B-3er- Bier Concerel 5 MM _ord2=2 EET. sath pit aly aguante Cops ann gael rigs Ga leben gues Horemer caida amar 003-—eu Web Fine anny 2009. @ Pad on eee paper US Govarnat Prining Ofow 2003.8 DUH 0280