REPUBLIC OF PALAU

The Ministry of Human Resources, Culture,
Tourism and Development.

EMAIL: [email protected] |
PHONE: +680 767 2452/1126|
FAX: +680 767 3354
EMAIL: [email protected] |
PHONE: +680 767 2452/1126 |
FAX: +680 767 3354

A. Plese check proper block

Plese check proper block

B. Buyers

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When applying for title with a co-owner other than your spouse, check one of the blocks below. If no block is checked, title will be issued as "Tenants in Commons."

C. Boat Data

Boat Length

D. Motor Data

Outboard Motor #1
Outboard Motor #2

E. LIEN

Lien
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F. Seller

I AM THE (CHECK ONE BLOCK)
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G. Agent

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J. I/We Certify underpenalty of law the statements made herein are true and correct to the best of my/our knowledge, information and belief.

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H.

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Purchase Price
Discounted/Collateral Value
Total Value = Line 1 + Line 2
Discounted or Collateral Value is the amount of discount given, or the value of the collateral used to secure the asset.
Marine and Transportation Safety Registration Fee
State Registration Fee
State Registration Fee
Grand Total - Add Lines 4 & 5

I.

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Was this boat ever registered or titled in PW?

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