HomeMy WebLinkAboutApplication APPLICANT 3/23/202110
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SUPPLEMENTAL DEAR UM ER
DEALER / REBUILDER VEHICLE EXPIRATION DATE
DEALER CERTIFICATE APPLICATION
EFFECTIVE DATE
• All supplemental locations must operate under the same ownership and
business name as shown on the current certificate. (ORS 822.040)
• Submit application with all required signatures and fees to: FEE: ❑ $350
Business Licensing Unit, 1905 Lana Avenue NE, Salem OR 97314
• Any alteration of Line 2 voids location approval.
• Chockit ❑ New Vehlcles [X1J d Vehicles.
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DEALER
CE TIFICATION —Must be si ned b the dealer—
False cert' lion is a ass misdemeanor under ORS 1 2.0 5 antl is punishable by six months in jail, a Ina of up to or
both. Inaddition, DMV sanctions against you or your dealer cerfificate may be imposed.
With the above penalties in mind, I CERTIFY:
I am the owner, a partner of a partnership, an LLC member, or a corporate officer of this business entity, and that all information on
this application Is accurate and true. This business deals in vehicles, or rebuilds vehicles at the location given. This supplemental
location will operate under the same ownership and business name as shown on the current cerbicate.
PRINTED NAME `.'�
TITLE
\�
SIGINATURE
EMAIL
X
SU EMENTAL BUSINESS LOCATION INFORMATION
Prop rty is (check Ong): ❑ OWNED >rLEASED f RENTED: LEASE OR RENTAL PERIOD:
If property is "Leased / Rented" complete the following:
P R'rYOWNER5 AILL E
) 1 9
)ER
TELEPI NNE NUAO
1
PRONEJRWOWNERMADDREW
ZIP WOE
LOCATION APPROVAL — I renewal, see instructions —
Certitication of Local Zoning and Business Regulatory Compliance. ORS 822.005 requires a vehic sdealer certificate, unless exempt
under ORS 822.015, for any person who:
(a) Buys, sells, brokers, trades or exchanges vehicles either outright or by means of any conditional sale, bailment, lease,
security interest, consignment or otherwise; OR
(b) Displays a new or used vehicle, trailer or semitrailer for sale; OR
(c) Acts as any type of agent for the owner of a vehicle to sell the vehicle dr acts as any type of agent for a person interested in
buying a vehicle to buy a vehicle.
THE CERTIFICATION BELOW IS TO BE COMPLETED,BY THE LOCAL ZONING OFFICIAL. Your approval below should be based
upon whether the applicant can do ANY of the activities listed in (a) through (c) above under your ordinances, at the location of the
business given on Line 2. Pursuant to ORS 822.025(6), applicant meets requirements below.
As the zoning official for the locafrty, in which this business is located, I verity by my signature below that the location of this business as stated on this application
complies with any land use ordinances and business regulatory ordinances of the city, or county, as appropriate pursuant to ORS 822.025(8).
CITY OF: COUNTY OF:
TELEPNONENUMBER
PRINT NAME
TIRE
SIGNATURE
DATE
'X
V Place stamp or seal here V