HomeMy WebLinkAboutBusiness License Application 1990-6-11
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NOTE: PLEASE READ INSTRUCTIONS ON PAGE ONE BEFORE COMPLETING THIS FORM.
FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY.
PLEASE TYPE OR PRINT LEGIBLY WITH INK.
PAGE TWO
FOR TYPE I BUSINESS ~TIFICATE ..
AS A DEALER OR REBU1LDER OF VEHICLES.' ~ 0 .
, ORIGINAL
[L] RENEWAL *
(See bonom right corner 01 page)
CERTIFICATE NO:
1 NAME (CORPORATION AND/OR ASSUMED BUSINESS NAME) BUSINESS TELEPHONE
...Jim!1J1P I Mnr'1~n 1]1'\1\' ..l I Mnrg~n Mn~.nl-< 747-5714
2 MAIN BUSINESS LOCATION (STREET AND NUMBER) CITY ZIP CODE COUNTY
1~5'i. Snll111 "A St. Snrinnfipld 9?477 Lane
31 MAILING ADDRESS CITY STATE ZIPCODE
1855 Smlt.h "A" St. Snrinnfield OR 97477
A SEPARATE SUPPLEMENTAL APPLICATION (FORM 372) MUST BE COMPLETED FOR EACH
ADDITIONAL LOCATION FROM WHICH YOU OPERATE YOUR BUSINESS,
41 CHECK ORGANIZATION TYPE: I IF CORPORATION, LIST THE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED:
o INDIVIDUAL IXI PARTNERSHIP 0 CORPORATION
00 YOU SELL THESE VEHICLE TYPES?
5
MOBILE HOMES
MOTOR HOMES
CAMPERS
[Z] YES 0 NO
[Z] YES 0 NO
[]] YES 0 NO
TRAVEL TRAILERS
MDTORCYCLES/MOPEDS
CLASS I A TVS
[Z] YES
[Z] YES
[]] YES
ONO
ONO
ONO
CLASS III ATVS
SNOWMOBILES
DD YOU REBUILD VEHICLES?
DYES ONO
[Z] YES 0 NO
o YES IX] NO
61 ARE YOU A FRANCHISED DEALER? 0 YES [)g ND I'F "YES," NAMETHE MAKEIS!:
I LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS DR PRINCIPAL CORPORATE OFFICERS:
7 NAME TITLE DATE OF BrRTH RESIDENCE TELEPHONE
~i.<> I M.n.r:gan Ol\ln<>r 1? mL28 (503 ) 746...5166
8 RESIDENCE ADDRESS CITY STATE ZIP CODE
_~~(..,?r:.. II~II ,+ "nY'in..afJ...elri (\Q Q~
9 fft~~v I Mnrn~n TIT'nwnpr D"i\~~~~WH RH:1)l1~c'7!l':?'~~'
10 ~~~~EN,9~~D11;~ESS ~~~ ; nnfi <> 1 rl STA1E Zc\'7~Of~ I
11 I NAME nilE I DATE OF BIRTH I RfSIDE'lCETELEPHONE 1
121 RESIDENCE ADDRESS CITY STATE ZIP CODE J
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 AT THE LOCATION GIVEN.
31 NAME I TITLE l RESIDENCE TELEPHONE
1 Jimmie L. Morgan Owner (503 )746-5166
141 ADDRESS, CITY, STATE, ZIP CODE I SIGNATUR6 -P
6625 "E" St., Springfield, OR 97478 X (;#.'..,~~ <) ..-.J. t t/f:vJ,.b--et0-...",..
I AGREEMENT TO ACT AS AGENT' Any dealer whowanls to be designated as a~ Agent 01 the Division must sW is agreement. By law, all Snowmobile, Class I AYland Class III ATV I
. dealers must act as aqents and must s!Q..n thiS 82!aement. -' /
II (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION. I (WE) AGREE TO COMPLY WITH ALL APPLICABLE I
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 INCIDENTAL EXPENSES DUE TO TERMINATION.
151 ~Gr1E.:. ',' 1 ~1 .'-..~~~ 1 TITLE rF)~) I DATt__ //- 77.) I
LOC~N APPROVAL: I CERTiFY T~AT THd~OCATiON SPECIFIED ABOVE $96.50
16 COMPLIES WITH ALL LAND USE OR BUSlt.tESS REGULATORY ORDINANCES BUSINESSCERTIFICA.TE FEE (INCLUDES ONE PLATE}
OF THE []I CITY 0 COUNTY OF
I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS
EVIDENCE OF ~ygH ^YTH9RITY 99 ^ffl~ HER~9N THE SEAL OR STAMr- OF
THE ciTY OR COUNTY.
ADDITIONAL LOCATIONS @ $30.00 EACH
(S!'!' ATT~~HI'R ~~r-mMI'NT^b ArrblgATlQN~1
ADDITIDNALPLAIP' @ $l1,50EACH
17 11ItJM.t1I., tvld-l- (IJC0J~fft/ll1/7/"
18 SIANlk~-l-1r1~. { c,AT_E'LO/,
x\"'-r" . " ,'7 /'1~
I I '.J m~fi1t\mwrEtlfE!. I
...........
TOTAL: $
c:lFTHIS IS A RENEWAL OF AN EXISTING CERTIFICATE, USE THE J
ATTACHED BILLING LIST TO CALCULATE PLATE FEES.
I THE ~ILLlNG LIST MUST BE SUBMITTED WITH YOUR RENEWAL APPLICATION
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