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FORM D-VH For Vessol Hull Design UNITED STATES COPYRIGHT OFFICE [REGISTRATION NUMBER. DVH 0319 ‘BATE OF REGISTRATIONPUBLIGATION 08 30 06 nth Dey ven DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE. » ARATE CONTINUATION SHEET, (Form D-VHICON) E, USE A, that embodies the design. re -CHAPARRAL SIGNATURE 276 TITLE (a) FBeeS PRS yee isgitraton is sought? FIBERGI LASS. MONO-HULL CABIN CRUISER. (b Provide a brief general statement setting forth the salient features of the design. ee Overall aestheti ince, including figuration, hull configuration, Denese" “and style lines deci Orcheck rere it Sethe (c) this design is derived ftom an erie design, deseiv how that design has ben revised, adapted, or rearrange. ote Form Baweon for adsitonal Provide the name and address ofthe designer(s). The name ofthe employer may be given instead of the designer(s) if, 1) the design was made within the regularscope ofemployment ofthe designer(s) and 2) the individual authorship ofthe designis difficult ‘orimpossible to ascribe. DESIGNER(S) % Please check here if those conditions are satisfied and you are providing the employer's name. ‘Name: __ Chaparral Boats, Inc. Name:_ Phares and Associates Address: P.O. Drawer 928 Address: 33228 W. 12 Mile Rd. Suite 317 300 Industrial Park Bivd. Farmington Hills, Ml_ 48334 Nashville, GA_31639-0928 If the owner is different from the designer(s) or employer named above, provide the name and address ofthe owner: ‘Name; Chaparral Boats, Inc. OWNER, 0. no oo iaaeaiPad Blvd. DESIGNERS) = ‘Was an application for registration of this design identified (b) Tf yes, identify the country and date of application: (€) inan application fled ins foreign country the extends tw» (O)) Country: designs of owners who are citizens of the United States, or Pmoriry ‘2 eons fling applications inthe United States, similar Date of application: protection to that afforded in 17 U.S.C. chapter 13? cua OYes WNo Serial No: e+ ‘Was this design made public before the date of application? @ Yes Q No Bs APPLICATION REC tyes, on what date? 6 — 27 2005 DATE MADE sd ad PUBLIC WORE ON BACK Pagel pees EXAMINED BY 7] 7 az FORM D-VH CHECKED BY CORRESPONOENGE FOR ‘CORRESPONDENCE, oar aye OFFICE ee ‘ONLY DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET, (rorm D-VHCON) 7 Please provide the name and address ofthe person to whom correspondence regarding this application may be directed: Name: William S. Pegg - CONTACT agiress: P.O. Drawer 928 PERSON Nashville, GA 31639-0928 ____ exmail address DD@GG@chaparralboats.com__ FAX number (229) 686-3660 ________ Daytime phone: ( 229 ) 686-7481 ———_—_ Give the name andaccount number f the registration fee is to be charged toa Deposit Account established in the Copyright Office: "Name of Account - DEPOSIT Account number: ACCOUNT ON 9 ‘DECLARATION: The undersigned, as the applicant or the applicant's duly appointed agent or representative, being hereby warned that willful false statements ate punishable by fine or imprisonment, or both, under 18 U.S.C. §1001, and that such willful false 1, hereby declares to the best of his/her knowledge statements may jeopardize the validity ofthis application or any resulting registr and belief: (1) that the design has been fixed in a useful article; (Q) thatthe design is original 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) that the design has not previously been registered on behalf ofthe applicant or applicant's predecessor in title; and (6) thatthe 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: "fn eliptical “Distinctive Owner Identitcaton’, with "Protected Design ‘across the top and "2005" across the bottom ‘Where on the useful article is the design notice located? CERTIFICATION AND SWORN STATEMENTS (On the transom, starboard side, above the radio remote control. If the undersigned is not the applicant, he/she is properly authorized to execute this application on behalf ofthe applicant OY - 6EPEL4L, _ Fine — So = William S. Pegg ‘ Vice President (223) 686-7481 (229) 686-3660 bpega@chaparralboats. com, Tiron novber FAK br Prat oe entry Peer e ene eee ee £Sipow snceten epee s Chaparral Boats, Inc. Rea TEercanngign naw nor ecombe P.O. Drawer 928 Same vinaow” |=" Nashville, GA 31639-0928 ee envelope Sion, 2008-300 Sane repnnennton hooey inorngy maven se epeeien ry far reseed ermrs 81260 any Honoree Wa sl ay Dave 8 @raraenccso%M yori a ce "20's cover $276 OVERHEAD DVH 0319 JUL 2 4 Zi ova Gy TE