A person who uses in this state a name, mark or device to indicate ownership of vessels, receptacles or utensils may file in the office of the secretary of state, on a form to be furnished or approved by him, a statement subscribed by such person and affirmed by him as true, under the penalties of perjury setting forth, but not limited to, the following information:
The statement shall include or be accompanied by a copy, specimen, facsimile or counterpart of such name, mark or device in quadruplicate, together with a filing fee of fifty dollars.
N.Y. Gen. Bus. Law § 276