Village of Mamaroneck Habor Master Dock App

Personal Information
Name of Owner*
Date of Birth*

MonthDayYear
Date
Age as of November 1st of this year.*
Address (Residence)*
City*
Are you a resident of the Village of Mamaroneck*

YesNo
Zip Code*
Home Phone*
Cell/Business Phone*
Email*
example@example.com
License plate of auto*
If you would like to purchase parking passes for additional vehicles, please list the license plates of the vehicles below.
Example) LVT 1234, ABC 5555, EAC 4367
Emergency Phone Contact*
Did you have a Float Permit last season?*

YesNo
Are you renewing a locker?*

YesNo
If you want a locker call (914) 777-7744 for availability.

Boat Information
Boat Name*
Boat Registration Number*
Boat Manufacturer*
Length*
Feet
Width*
Feet
Material*

WoodMetalGlass
Select one*

Power BoatSail BoatRow BoatKayak/SUP
Hull Color*
Copy of N.Y.S Boat Registration

If you do not have a digital copy of your boat registration and cannot obtain one, you may either drop off a copy at The Harbor Masters Office at 1 Harbor Island Park, Mamaroneck NY 10543 or mail a copy of it to Village Hall, P.O. Box 369, Mamaroneck, NY 10543.
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Copy of Certificate of Boat Insurance

If you do not have a digital copy of your insurance and cannot obtain one, you may either drop off a copy at The Harbor Masters Office at 1 Harbor Island Park, Mamaroneck NY 10543 or mail a copy of it to Village Hall, P.O. Box 369, Mamaroneck, NY 10543.
Cancelof

Agreement
For boats moored to Village-owned floats at Harbor Island:

My signature below certifies that I agree to conform with the regulations governing the use of floats duly posted for which this application is submitted, and to abide by all Harbor and Waterway Ordinances covering the operation of my boat in Mamaroneck Harbor.

I understand that float space is not transferable and should I sell or dispose of my boat, I will notify the Harbor Master immediately in writing.

I state that the information I am submitting on this application is in all respects true to the best of my knowledge.

False statements will result in immediate forfeiture.
Signature*

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Date*

MonthDayYear
Payment

Payment must be made in person at the Harbor Master's Office in Harbor Island, or, if paying by check, can be mailed to Village Hall at 123 Mamaroneck Avenue, Mamaroneck, New York 10543. Please see the fee schedule below to calculate the total amount.
Should be Empty:

Village of Mamaroneck Harbor Master - Application for Float Service Permit