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FORM D-VH For Vessel Hull Des : UNITED STATES. NGHT OFFICE REGISTRATION NUMBER | DWH 0356 BATE OF REGISTRATIONPUBLIGATION | 10 a oO on Dey You DO 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. Wobera 30 Scarab Tours TITLE — "What is the type or style of the design for which registration is sought? 2 (2) Fen oa (b) Provide a brief general statement setting forth the salient features of the design. DESIGN| “Tho features reat othe design ofthe deck andthe configuration ofthe hull _ check nore it 7 ay - Soon check here it SBetied () this designs derived fram an cats design describe how hat design as been revised, ape or erange. Tio hee ena Wa 0S pt rt Vs ale Rtn bv a ent ee a, ‘esign. Form . — WSICON {or addtional | 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 designen(s) and (2) the individual authorship of thedesignis difficult ‘or impossible to ascribe, DESIGNER(S) @ Please check here if those conditions are satisfied and you are providing the employer's name. Name: Wot Mane Name: ‘Address:_1651 Whitfield Avenue Sarasota, Florida 34243 _ Address: 2g) Nsaneplcation for regan of is deen denied (fy) If ys kent the county and date of application 5 (€) inn application filed in a foreign country that extends to (O.) Country: _ designs of owners who are citizens ofthe United States, or to persons filing applications inthe United States, similar Date of application: PRIORITY protection to that afforded in 17 U.S.C. chapter 13? ee QyYes_ No Serial No: py esos cones ace DATE MADE ee FUNDS AECENED PUBLIC ig WOREONBACK Tivbiniaaae pean Pageicl pees EXAMINED BY FORM D-VH 5 CHECKED BY cn CORRESPONDENCE eo ayes OFFICE USE ONLY DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET, (Form D-VHICON) lease provide the name and address of the person to whom correspondence regarding this application may be directed: / ‘Name: Apasien Sapmaz CONTACT 55; $200 IDS Center, €0 South Eighth Street, Minneapolis, Minnesota 55402 Person Mddress: et, Minna ee Email address _2580m#2@merchan-gou com FAX number £12222-081_ - Daytime phone: ( 612) "e-em Give the name and account number ifthe registration fee is tobe charged to a Deposit Account established in the Copyright Office: ‘Name of Account: DEPOSIT Account umber: ACCOUNT DECLARATION: The undersigned, asthe applicant or the applicant's duly appointed agent or representative, being hereby warmed 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 orany resulting registration, hereby declares tothe bestofhisorherknowledge and belie: (() that the design has been fixed in a useful article; . (Q) that the design is original and was created by the designer(s), or employer if applicable, named in the application; G) that those aspects ofthe design for which registration is sought are not protected by a design patent; (@) that the design has not previously been registered on behalf ofthe applicant or applicant's predecessor in title; and (5) that the applicant isthe person entitled to protection and to registration under chapter 13 of title 17, United States Code. © Complete if applicab ‘The design has been made public with a design notice as prescribed by 17 U.S.C. §1306. Following isthe exact form ofthe design notice: Where onthe useful atl isthe design notice located? CERTIFICATION AND SWORN STATEMENTS ‘Transom FF the undersigned isnot the applicant, je or hes propery authorized to exeout this application on behalf ofthe applicant gy a _ tlecfer7 ‘Apasian Sopmaz Pratorype nana 612-706-0089, 612.932-0081 Toiphone nabs? FRR ober Cortiicste anew wen | ann aoe Saecre NumbestureeuApe ¥ ergeee | ots cri Sau phn stot Sime: tom ee ea ‘SPUR gibr Penty tornne mprnenat ‘eign ander hs crop’ sal pay apoyo et Fev-Jue 2002-20000 Web Ror: Siy 2009 @ Prado oye paer US Goverment Pang ice: 2000-4651-1320,02 FiG. 1 wesc ‘ r tar pee tas