Advanced Elements ATTACK PRO Manuel Du Propriétaire page 16

Note: If your state requires the licensing of this boat, please use the form below. If you need any
assistance filling out this form, please contact Advanced Elements Customer Service Department.
MANUFACTURER'S STATEMENT OF ORIGIN (MSO)
Manufacturer's statement of origin for a vessel sold in the state of______________________________ ,
The undersigned manufacturer hereby certifies that the new boat described below, the property
of said manufacturer, has been transferred this _________day of _____________________, 20_________
on Invoice# _________________to:
Owner's/Dealer's Name____________________________________________________________
Address___________________________________________________________________________
City, State, Zip______________________________________________________________________
Model Name: Attack Pro Kayak (AE1051)
TM
Model Year _________
HIN# ___________________________
Type: Kayak
Hull Material: PVC/Polyester
Length Overall: 9ft 9in
Beam: 35 in
U. S. Coast Guard Capacity Plate Information (where applicable):
Maximum persons capacity in whole persons: 225 lbs (102 kg)
Maximum weight capacity (persons & gear): 225 lbs (102 kg)
The manufacturer further certifies that this was the first transfer of such new boat and that all
information given herein is true and accurate to the best of their knowledge
P.O. Box 5128 Concord, CA 94524
Signature_______________________
First assignment for value received, in the amount of $ ____________________________,
the undersigned hereby transfers the Certificate of Origin and the boat described therein
to ___________________________________________________________________________
Address _____________________________________________________________________
And certifies that the boat is new and has not been registered in this or any other state; Advanced
Elements, Inc. also warrants the title of said boat at time of delivery, subject only to the liens and
encumbrances as set out below:
Amount of Lien / Date to whom due
Address __________________________________________________________________________
Dates___________________________ 20 _________, at _____________________ ____________________
By:___________________________________________________________ Transferrer (Firm name)
Sign Here ___________________________________________________________
Before me personally appeared _____________________________ who by me being duty sworn under
oath says the statements set forth above are true and correct. Subscribed and sworn to me before this
__________ day of ___________________ 20 ___________. ___________________________________
Notary Public Date commission expires_______________ (SEAL)
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