Name of person reporting and telephone number ________________________________________________
( _______ ) ____________________
Description of boat
Type______________ Color__________ Trim___________
Registration No._________________ Length_____________
Name _______________ Make________ Other _________
Engine type________________________ H. P.___________
No. of engines _____________________ Fuel capacity_____
Automobile license number ___________________________
Type_________________ Trailer license________________
Color________________ Make of auto_________________
Where parked_____________________________________
Do any of the persons
on board have a medical
problem? Yes No
If yes, what?_____________________________
Trip expectations. Leave at_________________ am pm
From ________________ going to______________________
Expect to return by (time) _______________ am pm
and
not later than __________________________ am pm
Any other pertinent information?________________________
_________________________________________________
If not returned by (time) call the Coast Guard
or (local authority) ___________________________ am pm