Advanced Elements ATTACK PRO - Manufacturers Statement of Origin

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Note: If your state requires the licensing of this boat, please use the form below. If you need any
assistance lling 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 certies 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
TM
Pro Kayak (AE1051)
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 certies that this was the rst 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 Certicate of Origin and the boat described therein
to ___________________________________________________________________________
Address _____________________________________________________________________
And certies 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)