HomeMy WebLinkAboutPermit DMV License 1986-11-05UDetS b yb-Z 02/ x.r>eePs>-+. APPLI/" \TION FOR BUSINESS CERT'-'9ATE
I MU AS A DEALER Ok ,r,iBUlLDER OF VEHICLES (EXCEPT SNOWMOBILE.T rND ATV'S) CERTIFICATE NO.:
-
'
ffon,c,runlA
ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY LI RENEWALNOTES: FAILURETO
PLEASE TYPE OR PRINT LEGIBLY WITH INK
DO NOT SUBMIT APPLICATION WITHOUT YOUR SURETY BONO AND THE REOUIREO FEE.
NAME (CORPORATTON ANO/OR ASSUMED BUSINESS NAME}a^^4 C,om PAh YL,ue ( (r nq
BUSINESS TELEPHONE
726 -o82 7
MAIN BUSINESS LOCATION {ETREET AND NUMBER)
6Vq fclqeil.onf blav "'bP{/4,zrP cooE
g 7q1 ')COUNTYL<n€
MAILING AOORESS ,/
dA/,"L
ctw ,o-*<STATENK zrP cooEsb<
STREET ADDRESS crw ZIP CODE COUNTY TELEPHONE
STREET ADDRESS CITY zrP cooE COUNTY TELEPHONE
CHECK ORGANIZATION TYPE:
E truorvroult- I peRrruensnrp E conponnrron
IF CORPORATION, LIST THE STATE UNOER WHOSE LAW BUSINESS IS INCORPORATED
7?4
LIST NAME AND RESIDENCE ADORESS OF ALL INDIVIOUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS
rlrck /t / e//, "q
NAME t'"'/o-ot
o anq DATE OF BIRTH
z/ zu/ 17
RESIDENCE TELEPHONE
( to3) 7 2 L-O 627
nesroer'rce ADDRESS I
/o? ,/ f ,(ao,^on* (/at4-c,ry Vf=(4,sI^rE&ZIP CODEq7 L/? 7
NAME TITLE DATE OF BIRTH RESIDENCE TELEPHONE
()
CITY STATE ZIP CODERESIOENCE ADORESS
NAME TITLE DATE OF BIRTH RESIDENCE TELEPHONE
()
RESIDENCE ADDRESS CITY STATE ZIP CODE
ARE You A FRANCHTSED DEALER? n ves
nruo
IF YES, NAME THE MAKE(S):n cHecx rF You sELL MoBTLE HoMES
E cxecx rF You REBUTLo vEHTcLES
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 LOCATTON(S) G|VEN. / ,''"'fr<-t 6ilh€f RESIDENCE TELEPHONE
t SoSt 7zl-o827
NAME 7"ilL AUU'q qwzrP cooEAOOBESSSTA "n**flUu U'1!4
nlaeer.,tEr.ri ro nilns AGENT: r uel wrsH,/o ae oesrCNnrED AS A t-tt'itreo AGENT FoR THE MoroR vEHTcLES otvrstg/t (wE)AGREE
ro coMpLy wtrH ALL AppLtcABLE t-lws Mro ADMrNrsrRATrvE RULES AND AGREE To HoLD THE orvrsroN HARMLESS OF nuv Loss oR
EXPENSE RESULTING FROM ANY ACTS OR REPRESENTATIONS IN EXCESS OR IN CONTRAVENTION OF AGENT'S AUTHORITY, AND FROM
TNcToENTAL EXPEN|,SES DUE TO TERMTNATION.
SIGNATURE I;"n;;4. Uetl*"'Tt/ {/{b
LrsT THE ADDRESSES OF ALL ADDITTONAL BUSTNESS LOCATTONS. A SEPARATE APPLICATTON (FORM 371) MUST BE COMPLETED FOR
ANY ADDITIONAL LOCATIONS IN A DIFFERENT CITY OR COUNTY.
I CERTIFY THAT LOCATION SPECIFIED ABOVE COMPLIES
REGULATORY OROINANCES OF THE BUSTNESS cERrFrcArE FEE (rNcLUoES oNE pLArE) $96.00WITH ALL LANO USE OR! crrv fl couruw or
I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS
EVIOENCE OF SUCH AUTHORITY OO AFFIX HEREON THE SEAL OR STAMP OF
THE CITY OR COUNTY.
NAME TITLE
TURE DATE
$
NOTE: lF THIS lS A RENEWAL OF AN EXISTING CERTIFICATE USE THE
ATTACHED BILLING LIST TO CALCULATE PLATE FEES.
AOOITIONAL LOCATIONS
AODITIONAL PLATES
@ $30.00 EACH
@ $11.00 EACH
735.370 #$dfltrg!"o'*'8u",GF3 RINfiFiEI.D
TOTAL: