SECRETARY OF THE STATE OF CONNECTICUT MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106 PHONE: 860-509-6002 WEBSITE: www.concord-sots.ct.gov NOTICE OF VESSEL LIEN C.G.S. �49-55a USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): CUSTOMER ID: NAME: ADDRESS: FILING FEE: $50 MAKE CHECKS PAYABLE TO "SECRETARY OF THE STATE" CITY: STATE: EMAIL: TO ALL PERSONS WHOM IT MAY CONCERN, A LIEN IS CLAIMED BY ME ON THE BELOW DESCRIBED VESSEL: 1. OWNER'S NAME IF INDIVIDUAL SURNAME OR FIRST PERSONAL NAME ORGANIZATION ORGANIZATION NAME MAILING ADDRESS: (STREET OR P.O. BOX) ADDRESS: MIDDLE SUFFIX ZIP: CITY: STATE: ZIP: COUNTRY: 2. CLAIMANT'S EXACT LEGAL NAME IF INDIVIDUAL SURNAME OR FIRST PERSONAL NAME ORGANIZATION ORGANIZATION NAME MAILING ADDRESS: (STREET OR P.O. BOX) ADDRESS: MIDDLE SUFFIX CITY: STATE: 3. NAME OF VESSEL ZIP: COUNTRY: 4. REGISTRATION NUMBER 5. DESSCRIPTION OF VESSEL AND NAME OF MANUFACTURER PAGE 1 OF 2 FORM UVESSEL-1-1.1 Rev. 7/2013 American LegalNet, Inc. www.FormsWorkFlow.com 6. HULL NUMBER 7. REGISTRATION NUMBER 8. TYPE OF PROPULSION 9. LENGTH 10. LOCATION OF VESSEL 11. AMOUNT OF CLAIM 12. BASIS OF CLAIM WITH DATES INTENDED SALE (If applicable -- at least 60 days next succeeding filing of such notice) DATE OF SALE CLAIMANT'S SIGNATURE PLACE OF SALE DATE PAGE 2 OF 2 FORM UVESSEL-1-1.1 Rev. 7/2013 American LegalNet, Inc. www.FormsWorkFlow.com