STATE OF FLORIDA CERTIFICATE OF INSPECTION FOR HOMEMADE VESSELS

Control # ___

I, _________ (Print or Type) hereby certify that I have personally inspected the vessel described below and that it meets the legal definition of a homemade vessel as defined in Section 327.01(21), FS.

Name of Applicant: _________ Date of Inspection: _____

Length: ____________ Fuel: [ ] Gas: [ ] Diesel: [ ] Other: _______________

VESSEL TYPE HULL MATERIAL PROPULSION

[ ] Runabout [ ] High Perf. [ ] Wood [ ] Fiberglass [ ] Outboard [ ] Inboard/Outboard

[ ] CabinCruiser [ ] Sailboat [ ] Alum. [ ] Wood/F.G. [ ] Inboard [ ] Air Prop.

[ ] Bass Boat [ ] Fishing [ ] Steel [ ] Other _____ [ ] Sail [ ] Other _____

[ ] Airboat [ ] Center Console

[ ] Houseboat [ ] Dinghy

[ ] Trawler [ ] Other ___

Specific Comments: _____

Organization: [ ] FMP [ ] GFWFC Region # _________ Badge # ________

__________________________

Signature of Inspecting Officer

DEP 20-126-FMP

Rulemaking Authority 327.04 FS. Law Implemented 328.01(6) FS. History–New 10-16-84, Formerly 16N-34.04, 16N-34.004, 62N-34.004.