HomeMy WebLinkAboutBusiness License Application 1986-10-27
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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.
- APP~TION FOR BUSINESS CER_CATE 0
AS A DEALER JI!II'lEBUILDER OF VEHICLES (EXCEPT SNOWMOBI;J!I..ND ATV'S)
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ORIGINAL
RENEWAL *
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CERTIFICATE NO'
I NAME (CORPORATION ANDIOR ASSUMED BUSINESS NAME) I BUSINESS TELEPHONE
O-RAC INDUSTRIES DBA L & S AUTO SALES 741-1303
I MAIN BUSINESS LOCATION (STREET AND NUMBER) CITY . ZIP CODE I COUNTY
2 305 South A St. Springfield 97477 LANE
I MAILING ADDRESS CITY STATE I ZIP CODe
3 255 South A St. Springfield OR 97477
LIST THE ADDRESSES OF ALL ADDITIONAL BUSINESS LOCATIONS. A SEPARATE APPLICATION (FORM 371) MUST BE COMPLETED FOR
ANY ADDITIONAL LOCATIONS IN A DIFFERENT CITY OR COUNTY.
1 STREET ADDRESS City
4 NONE
5 I STREET ADDRESS CITY ZIP CODE COUNTY TELEPHONE
I CHECK ORGANIZATION TYPE: IF CORPORATION, LIST THE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED
6 0 INDIVIDUAL 0 PARTNERSHIP 00 CORPORATION OREGON
7 I LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS
I NAME TITLE I DAT~ OF BIRTH I RESIDENCE TELEPHONE
8 LESTER C. SWAGGART JR. PRESIDENT 8/13/35 (503) 686-9357
I RESIDENCE ADDRESS CITY I STATE I ZIPCODE
9 2310 Terrace View Dr. Eugene. OR 97405
10 I NAME MODESTA A. SWAGGART ---- TITLESECRETARY ~ DA8'~~i'~6" I ~E~~E~~~~~~;;;E
I RESIDENCE ADDRESS I CITY I STATE I ZIP CODE
11 2310 Terrace View Dr. Eugene OR 97405
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I NAME--- -- TITLE DATE OF BIRTH RESIDENCE TELEPHONE
12 ( t
I RESIDENCE ADDRESS CITY STATE ZIP CODE
13
I ARE YOU A FRANCHISED DEALER? D YES IF YES, NAME THE MAKE(S): I D CHECK IF YOU SELL MOBILE HOMES
14 ~ NO D 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.
I NAME I TITLE I RESIDENCE TELEPHONE
16 LESTER C. SWAGGART PRESIDENT,rJ (503 I 746-2845
17IADDRESS,CITY,STATE,ZIPCODE I~~ (!! tl
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AGREEMENT TO ACT AS AGENT: I (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION. (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 CONTRAVENTION OF AGENT'S AUTHORITY, AND FROM
INCIDE~ EXPENSES DUE TO TERMINATION.
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ZIP CODE
COUNTY
TELEPHONE
15
18
I TITLE
PRESIDENT
I DATE
10/27/86
APPROVAL: I CERTIFY THAT EACH LOC.A: I N SPECIFIED VE COMPLIES
WITH AU LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE
20 0 CITY 0 COUNTY OF
BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE)
$96.00
AOomONAL LOCATIONS
~ $30.00 EACH
21
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.
. ADDmONAL PLATES
@ $11.00 EACW
22 I NAME TITLE
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23 I SIGNATURE . DATE
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735-370 (4-86) - - v-EII "'LU .CJj"
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* IF THIS IS A RENEWAL OF AN EXISTING CERTIFICATE USE THE
. . . ATTACHED BILUNG LIST TO CALCULATE PLATE FEES.
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