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Home My WebLink AboutBusiness License Application 1986-12-15 ~ct?GE!"....,",,> ~rn[D]W APpAA TION FOR BUSINESS CER.ICA TE AS A DEALER OR REBUILDER OF VEHICLES (EXCEPT SNOWMOBILe'; AND ATV'S) ~ o RENEWAL * ORIGINAL NOTES: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY PLEASE TYPE OR PRINT LEGIBLY WITH INK DO NOT SUBMIT APPLICATION WITHOUT YOUR SURETY BOND AND THE REQUIRED FEE. CERTIFICATE NO: I NAME (CORPORATION ANO/O~U~E':.1USINESS NAME) B7N.r?TE~,?Ni / ! lauCO I MAIN BUSINESS LOCATION (STREET AND Nl.1M~E~. _ If crr ~ f d ZIP CODE CO~ 2 j{lq ~ '(i-' ~ /Q,I4_~o.L..JC( 17'17'7 ~ 3IMi'~GqDDR~ 'A"~'- C1'/lA.6IWJ &'~ ZI"ctr'/7'7 LIST THE ADDRESSES OF ALL ADDITIONAL BUSINESS LO~~;:: j~ARATE APPLlCATION~ 371) MUST BE COMPLETEO FOR ANY AODITIONAL LOCATIONS IN A DIFFERENT CITY OR COUNTY, STREET ADDRESS CITY ZIP COOE r COUNTY I TELEPHONE 5 STREET ADDRESS CITY, ZIP CODE l COUNTY I TELEPHONE CHECJ$..PRGANIZATION TYPE: IIF CORPORATION, USTTHE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED 6 ~DIVIDUAL 0 PARTNERSHIP 0 CORPORATION 4 7 LIST NAME AND RESIOENCE AOORESS OF ALL INOIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS 8INA19~ ~~ I TITLE .c ~ RESIDENCE ADDRESS H I CITY 9 38310 wJ_ 6'-'6_ ~ NAME TITLE DATE OF BIRTH 7IN/:2. '7 ~"E ' - DAT~ RESIDENCE TELEPHONE- t t 11 I RESIOENCE AOORESS ,- CITY STATE ZIP CODE 12 I NAME r"' I TITLE DATEOFBIRTH .- ~ESIDE~CETELEPHONE 13 I RESIDENCE AODRESS .-- 'CITY STATE ZIP CODE I ARE YOU A FRANCHISED DEALER? 0 YES IF YES, NAME THE MAKE(S): ~CK IF YOU SELL MOBILE HOMES 14 _ _ _ _ n_ Ql..no , rn-cHECK IF YOU REBUILD VEHICLES I CERTIFY THAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTATIVE AND THAT ALL INFORMATION ON THIS APPLICATION IS ACCURATE AND TRUE. I CERTIFY THAT THE BUSINESS DOES OR WILL DEAL IN, OR REBUILDS VEHICLES AND IS OR WILL BE ESTABLISHED AT THE LOCATION(S) GIVEN, NAME 10 ~ 15 16 I TITLE I RESIDENCE TELEPHONE ( ) I ADDRESS. CITY. STATE. ZIP CODE 17 I ~GNATURE 18 AGREEMENT TO ACT AS AGENT: I (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION, I (WE) AGREE TO COMPLY WITH ALL APPLICABLE LAWS AND ADMINISTRATIVE RULES AND AGREE TO HOLD THE DIVISION HARMLESS OF ANY LOSS OR EXPENSE RESULTING FROM ANY ACTS OR REPRESENTATIONS IN EXCESS OR IN CONTRAVENTmN OF AGENT'S AUTHORITY, AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION. 19 ;GNA7~~g~ ITlTLE ~ . APPROVAL: I CERTIFY THAT EACH LOCATION SPECIFIEMOVE COMPLIES wrIH...AtL LAND use OR BUSINESS REGULATORY ORDINANCES OF THE 0',CITY q C~~~...O~ I} "-"~ I ~~~;RIZED TO SIGN THIS APPUCATION AND AS EVIDENCE OF SUCH AUTHORITY 00 AFFIX HEREON THE SEAL OR STAMP OF THE CITY OR COUNTY. I DATE. BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) $96.00 20 ADDITIONAL LOCATIONS @ $30,00 EACH 21 ADDITIONAL PLATES @ $11,00 EACH 22 I NAME TITLE I TOTAl' $ ~"'( ..:,. ~-r -n-au. coca:.. ~I.u 23 I SIGNATURE ,...u.-.- DATE 1 Ifij~~rl:~~A~~ OR ~EAL ~ERE:'2{I5/'is{.. I [* IF ~~~~HAE~E~~~:~ ~I~~~;~~~~~~::~~~~~~~;.E THE 135'370 (4.86) . . , ~ i\".ij 6 T Ul!- ~~"'~';;'U"ll~r~i;;;.LO NOTE: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY PLEASE TYPE OR PRINT LEGIBLY WITH INK .......----..--: ----- ~ CERTIFICATE NO: 1INAME(CORPORATIONANO/Or;aac~ ~ ~ ~ B'f7r1S~L~q7f 2 I MAIN BUSINESS LOCATION (STREETAN7(NUM' ~RV ~29 ~a~A Street \ ]\ZIPCODE 7 COU"" A ~ / ,..,..".. f:J., , lCJ 7 '-I? ~ 31 MAILING ADDRESS b;PIIIIY liCUf Uf1 !J74i7 V1 STATE '1'ft4 7 '7 A SEPARAT~ SUP EMENTAL APPLICATION (FORM ~UST BE COMPLETED FOR EACH ADQITION OCATION FROM WH~ 9PERATE YOUR BUSINESS. 4\ c.!PCKORGANIZATIONTYPE: ""'- _ - I ''''l".rfRPORA~ISTTHESTATEUNDERWHOSELAWBUSINESSISINCORPORATE0 lA!.INDIVIDUAL D PARTNERSHIP ~ORATIO~ 00 YOU SELL THESE VEHICLE TYPES? ~ APPLlCA'& FOR TYPE I BUSINESS &TIFICA TE D ORIGINAL '0-RENEWAL * AS A DEALER OR REBUILDER OF VEHICLES l~rn[D]VI' 5 MOBILE HOMES MOTOR HOMES CAMPERS [lJ YES D NO IZI YES D NO 121 YES D NO TRAVEL TRAILERS MOTORCYCLE/MOPEOS CLASS I ATVS IZJ YES D NO ~ YES D NO r:l] YES D NO SNOWMOBILES 00 YOU REBUILO VEHICLES? DYES D NO .JKl YES D NO 61 AREYOU A FRANCHISED OEALER? 0 YES ~ NO I'F"YES",NAMETHEMAKE(S); I LIST NAME ANO RESIOENCE ADDRESS OF ALL INOIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS 71' NAME / (J - . (),o 11 D Ji '-:-1. TITLE,....,. _>A 0 -", DATEqFBIRTH d I RESIDENCE TELEPHONE J ~ ~/~V'-' {./"'-' --- '7/11//2fl (S'o.:<) 7 <17-1.. :30 8 L"Es:f)iC~A~D~ES~-IW'1 ;,-8 CITY ~ ST!9~ Z1PFf~EJ./3.j 91 NAME t TITLE DATEOFB~TH I RfsIDE~CETELEPHONE 10 [AE$IDENCEADDRESS _ CITY STATE I ZIPCODE 11 I NAME TITLE DATE OF BIRTH RfsIDElcETELEPHoNE- 121 RESIDENCE ADDRESS -- CITY STATE .____ _ZIP CODE ,n I CERTIFY THAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTATIVE AND THAT ALL INFORMATION ON THIS APPLICATION IS ACCURATE AND TRUE. I CERTIFY THAT THE BUSINESS DOES OR WILL DEAL IN VEHICLES, OR REBUILDS VEHICLES AND IS OR WILL BE ESTABLISHED ATTHE LOCATION GIVEN. 1 NAME 1 TITLE I RESIDENCE TELEPHONE 13 OAV/(3. Russe.ll ~M.ITh ~ (,5'"03) 7Y7'~ 3C/ 141 ADDRESS, CITY, STATE, ZIP CODE In J- J SIGNATURY / / ~.~. c-V 3& 310 Hwy 58 ~CJ~ 97'13 / x /[{('/' _c":t't^.~ 7t- I AGREEMENT TO ACT AS AGENT: (YOU MUST SIGiHHIS AGREEMENTlF YOU SELL .SNOWMOBILES <?RCI: SS I ATv'S) I (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION, I (WE) AGREE TO COMPLY WITH ALL APPLICABLE LAWS AND ADMINISTRATIVE RULES AND AGREE TO HOLD THE DIVISION HARMLESS OF ANY LOSS OR EXPENSE RESULTING FROM ANY ACTS OR REPRESENT IONS IN EXCESS 01W'l CONTRAVENTION OF AGENT'S AUTHORITY, AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION. 15 ~GNAI E ~$~A rTL~ 17~ /1 -28 16 APPROVAL: I CeRTIFY THAT THE LOCATION SPECIFIED ABOVE COMPLIES WITH A~ USE OR BUSINESS REGULATORY ORDINANCES OF THE Ql-CiTY 0 COUNTY OF BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) $96.00 I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS I EVIDENCE OF SUCH AUTHORITY DO AFFIX HEREON THE SEAL OR STAMP OF THE CITY OR COUNTY. 1 71 NAME TITLE I ~.",t ,,?, ""'" V~P~T ~ _>.1 81 SIGNATURE () \,_i~ DATE I 1 X~b , Witm 1/13/270 * IF THIS IS A RENEWAL OF AN EXISTING CERTIFICATE USE THE I\) u 6 . I ATTACH EO BILLING LIST TO CALCULATE PLATE FEES. (PLA' oA"""OVEDL HERE) F' E'''' I THE BILLING LIST MUST BE SUBMITTED WITH YOUR RENEWAL APPLICATION ~TV flF SPRING I ... - SUB~~~, ,I.""I,,~._ .,ah... ~_NDWITHALLREQUIREDSIGNATURESANDFEESTO: BUSINESS LICENSING UNIT, 1905 LANA AVE, NE, SALEM, OR 97314-2350 ADDITIONAL LOCATIONS @ $30.00 EACH (SEE ATTACHED SUPPLEMENTAL APPLICATIONS) AODITIONALPLATES @ $11.00 EACH TOTAL; $ 735-370 (9-87) ~rn[U]w AS A OEALER OR REBUILDER OF VEHICLES 5 MOBILE HOMES 0'YES D NO TRAVEL TRAILERS ~S D NO SNOWMOBILES DYES D NO MOTOR HOMES ~S D NO MOTORCYCLES/MOPEDS . YES D NO DO YOU REBUILD CAMPERS . YES D NO CLASS I ATVS ca-vES D NO VEHICLES? IB"YES D NO 61 ARE YOU A FRANCHISED DEALER? 0 YES ~O IIF "YES," NAME THE MAKE(S): LIST NAME ANO RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS: 7 NAME ----- TITLE DATE OF BIRTH RESIDENCE TELEPHONE ( ) ZIP CODE 8\ RESIDENCE ADDRESS ___________ CITY STATE 9 I NAME ;-rrrt!-____ DATE OF BIRTH 10 I RESIDENCEAODAES$ CITY TATE 11 I NAME - TITLE DATE OF BIRTH 121 RESJDENCEAOORESS CITY STATE ZIP CODE ---- I CERTIFY THAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTATIVE AND THAT ALL INFORMATION ON THIS APPLICATION IS ACCURATE AND TRUE. I CERTIFY THAT THE BUSINESS DOES OR WILL DEAL IN VEHICLES, OR REBUILDS VEHICLES AND IS OR WILL BE ESTABLISHEO ATTHE LOCATION GIVEN. RfSIDE~CE TELEPHONE ZIP CODe 131 NAMED R U ,R . II C' :-1'--1 J TITLE 0 I RESIDENCETE~~PHONE - ' Id uss,e -',flftHI -rO-I"t..u...<- /\ ()7Y7~~OI 14IA'JgR~.~ITY,STATE,iIPCODj,._(~ (1 .'~ .-<1 Ct'7i/3/jSIGNAIr'1/ &t2 f!./ f//,...-..,LI ..:X:5 ~ /0 H uy :; 0' Ir.\)!)~-U l~ 'Yl X /( (k---&,- ....5' -, :...r~-1. I AGREEMENT TO ACT A" AGENT" Any dealer who'hants to.bed8.signaled as an "'genlolthe Division muslsigfnhbagreemen . Bylaw, all Snowmobile and Class I ATV dealers must I ;0) . acl as aaents and must SI9." thiS ~Q~eemenl. II (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION, I (WE) AGREE TO COMPLY WITH ALL APPLICABLE \ LAWS AND ADMINISTRATIVE RULES AND AGREE TO HOLD THE DIVISION HARMLESS OF ANY LOSS OR EXPENSE RESULTING FROM ANY ACTS OR REPRESENTA,T~NS IN EXCESS OR IN CONTRAVENTIO.H'DF ApENT'S AUTHORITY, AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION. 151 ~GNATU:I(~~'/~~~L~~-:.$1f TITLE O'U'1'l.LI1. D 1/ 0 C () 1 Dt"- 4 - 81 I 16 APPROVAL: I CERTIFY THAT THE LOCATION SPECIFIED ABOVE COMPLIES WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE o CITY 0 COUNTY OF BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) $96.50 17 18 I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS EVIDENCE OF SUCH AUTHORITY DO AFFIX HEREON THE SEAL OR STAMP OF THE CITY OR COUNTY. NAME TITLE ~.kt">I2-'L "'? Ur5TI TJF-'~f~~t::lZ ~~\ SIGNATURE (6 \' _A...'n DATE X~n , ,~~ /. ~ \}rclB1 * IFTHIS IS A RENEWAL OF AN EXISTING CERTIFICATE, USE THE O ATTACHED BILLING LIST TO CALCULATE PLATE FEES, .. (PL", .t::>lt\IVI.....URtiE~LHERE) nr ~ I,.',' ,. ,'...' I THE BILLING LIST MUSTOE SUBMITTED WITH YOUR RENEWAL APPLICATION SU8 .(ti\l>RilicA~~r~ETY I.OND WITH ALL REQUIRED SIGNATURES AND FEES TO: D,,';;;~;;5S LICENSING UNIT, 1905 LANA AVE. NE, SALEM, OR 97314-2350 ADDITIONAL LDCA liONS @ $30.00 EACH (SEE ATTACHED SUPPLEMENTAL APPLlCA liONS) AOOITlONALPLATES @ $11.50 EACH TOTAL; $ 735-370 15.SS) Proc:lucedby STATE PRINTING