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Form D-VH Du 0326 DATE OF REGIGTRATIONPUBLICATION "1 a7 06 Mea a yew! DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. (Form D-VH/ICON) Please give the make and model of the vessel that embodies the design. CHAPARRAL 275 SSI _ _ TITLE — — — —— (a) Waste Be peor eof the desig fo which gation i sought 2) FIBERGLASS MONO-HULL CUDDY CABIN SPORT BOAT Drewcn(b) Provide brit general statement sting forth the salt fetes of the design. and style lines. regaterog If this design is derived from an earlier design, describe how that design has been revised, adapted, or rearranged. sgn. ©, Provide the name and address ofthe designer(s). The name of the employer may be given instead ofthe designer(s) if, (1) the design was made within the regular scope of employment ofthe designer(s) and (2) the individual authorship ofthe design is dificult or impossible to ascribe. DESIGNER) © Please check here if those conditions are satisfied and you are providing the employer's name, Name: Chaparral Boats, Inc. Name: a oe Address:, P.O. Drawer 928 — Address: 309 Industral Park BIvd._ a — —_ -Nashville, GA 31639-0928 —— - — Ifthe owner is diferent from the designers) o employer named above, provide the name and address ofthe owner: Name: OWNER, TeNOT Address: noe ee ~— DESIGNERS) essa sppeatonforrpoalon of is Ges denied (yy Iyer Men he conn and dats of option: (a) in an application filed in a foreign country that extends to Country: designs of owners who are citizens ofthe United States, or PRIORITY to persons filing applications in the United States, similar Date of application: ~ a protection to that afforded in 17 USC chapter 137 ee OyYes No Serial No: — ‘Was this design made public before the date of application? Q Yes Q No Ce n« 7 tyes, on what date? S-__¥2_____— 2008. Ee 4 DATE MADE IBE ewosncceneo PUBLIC B Page tot emcee eam nanenameenee came EXAMINED BY FORM D-V RECKED BY SORERRONE ron CORRESPONDENCE cot ar ayes. OFFICE BE onty DONOT WRITE ABOVE THIS LINE IF YOU NEED MORE SPACE, USE A SEPANATE CONTHUATION SHEET, Form DUHTCOM Please provide the name and address of the person to whom correspondence regarding this application may be directed: 7 Name: Mike Fafard _ _ ee _ __ CONTACT Agdess: P.O. Drawer 928 PERSON Nashville, GA 31639-0928 _ Email address Mfafard@chaparralboats.com Daytime phone: ( 229 ) 686-7481 ‘Name of Account: 8 Give the name and account number ifthe registration fee is to be charged to a deposit account established in the Copyright Office: DEPOSIT Account number: ACCOUNT DECLARATION: The undersigned, asthe applicant or the applicant's duly appointed agent or representative, being hereby warned that willful false statements are punishable by fine or imprisonment, or both, under 18 USC §1001, and that such willful fase state- ‘ments may jeopardize the validity of this application or any resulting registration, hereby declares tothe best of his or her knowledge and belif: (1) thatthe design has been fixed in a useful article; (@) thatthe design is original and was created by the designers), or employer if applicable, named in the application; (@) that those aspects of the design for which registration is sought are not protected by a design patent; (that the design has not previously beea registered on behalf of the applicant or applicants predecessor intitle; and (5) tha the applicants the person entitled to protection and to registration under chapter 13 of ttle 17, United States Code. ‘Complete if applicable: ‘The design has been made public with a design notice as prescribed by 17 USC §1306. Following isthe exact form of the design notice: An elliptical "Distinctive Owner Identification” with "Protected Design” across the top and "2006" across the bottom ‘Where on the useful article isthe design notice located?” © CERTIFICATION AND SWORN STATEMENTS Aft starboard quarter___ — a If the undersigned is not the applicant, he or she is properly authorized to execute this application on behalf of the applicant. 7" v wg@ICL..Lo ,. L006 Mike Fafard ( Vice President of Engineering Pet pn ae Peon ine (229) 686-7481 (229) 686-6330 mfafard@chaparralboats.com Sepa tena nat woo ceed a ht Office, or call (202) 707-3000, Cortese ie Muietin Chaparral Boats, Inc. Window” mee 6 tm” P.O. Drawer 928 Sharia address: Chy/Stateip —— Nashville, GA_ 31639-0928 Se [ET G8C Sar Pray tori rpreoraton Von town malar he repeetaaen reat alec ha igus cuunae wa ba Gap he papoose county persion ee ony ‘etre apo aye pany te hn $00 mt rer an 0, eo te pees aa! May hve ep we apo a end Farm O/H ev:072008 Pi 572008. nnn pap US. Goverment Pring Oe: 2008 275 SSI OVERHEAD DVH 0326 N OF CONG é fe Phe 275 SSi NOV 06 2006 23