HomeMy WebLinkAboutMiscellaneous Application 1988-12-28
OREGON ~ T W
MOTOR
VEHICLES III
DIVISION
-
-~
.",.
.
.
SUPPLEMENTAL DEALER/REBUILDER BUSINESS CERTIFICATE
APPLICATION
CERTIFICATE NO:
NOTES: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE DELAY
PLEASE TYPE OR PRINT LEGIBLY WITH INK
ALL SUPPLEMENTAL LOCATIONS MUST OPERATE UNDER THE SAME
OWNERSHIP AND BUSINESS NAME AS SHOWN ON THE CURRENT
CERTIFICATE
*-
NAME (CORPORATION AND/OR ASSUMED BUSINESS NAME)
Great Western Mobile Home Sales & Listing, rne
I SUPPLEMENTAL LOCATION (STREET AND NUMBER) CITY
2 1735 Highway 99N Eugene
I MAILING ADDRESS CITY
3 1735 Highway 99N Eugene
I MAIN BUSINESS LOCATION
4 5024 Main St Springfie1dr Or 97478
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.
NAME I TlTLESd, (f ~
5 f;.-{,cd.V/<?.s'h-Pifrlj"J, l[,.,.. <;" \~__ r~
AD~R.ESS,CITY,STATE. IP~ODE' ~'" j.. I SIGNATURJ'r_
6 b 0 dv '-/ I'Y)<>-., ..., ~~ ~, ~r. -1",_/..( (") ~~ c; 7-17 'ii X r<I ~. ? -'Yl::::1 r~._
APPROVAL: I CERTIFY THAT THE ~CATION SPECIFIED ABOVE COMPLlES"10 I CERTIFvTHAT SURETY BONIJit), llU,jI:>..U
WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OFTHE WILL COVER THE BUSINESS OPERATION AS SUPPLEMENTED ABOVE.
isJ CITY 0 COUNTY OF
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
BUSINESS TELEPHONE
1
97402
726-2171
COUNTY
Lane
ZIP CODE
ZIP CODE
STATE
Or
97402
DI vC'c..'roY' 5>
I RESIDENCE TELEPHONE
(503) ") 'f7 '-;:"0(,1
7
8
9
TITLE
~_ ~ ~Z:SEA:ER~
SIG TUREOF SURETY/REPRESENTATIVE
ttornev-in-faet 12/07/88
TITLE DATE
'\ ,
DATE
""'/) I :A -eVA-
- - "----=- -
FEE: $3000
SUBMIT APPLICATION WITH ALL REQUIRED SIGNATURES AND FEES TO:
BUSINESS LICENSING UNIT
1905 LANA AVE, NE
SALEM OR 97314-2350
KaX/lLII7'IML xalV/) ICA I~ .OR TYPE I BUSINESS CE.FICATE AD~
11 . AS A DEALER OR REBUILDER OF VEHICLES D
C;Uj fn.4it ill~/}) ORIGINAL
D RENEWAL*
'4CUjl jna"-v 12~ ;OMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY. (S..bott"'H~hICO,""Olp.g.)
;IBLY WITH INK. CERTIFICATE NO: /o'l-'f
lED BUSINESS NAME) I } BUSINESS TELEPH?w1NE
I I <.....!:f..(> r W~~il1Zj:-l Jfl71 bl'lp N()I7'IJ.':' 503 - 7d-fo..;J.
21 MAIN BUSINE~S LOCA.~ION (STREET AND NUMBER) CITl- fI ZIP CODE COUNTY
50().4~lErA/=-- oJjJrJ/i'Cj Iteld Or. q7r/-7R Ll4-ne_
cr~MAI6NG~~ESS ---------_-... ~ CITY STATE ZIPCODE I
' ",,5'0';;'4 fYJallv / \) .:5pr/n9be!<i -(fTK. (JIG 47ft1tJ "17t/-7cY
A_~~AR :re-5UPPLEMENTAL APPLICATION (FORM 372) MUST BE COMPLETED FOR EACH
~ _ ADDITIONAL LOCATION FROM WHICH YOU OPERATE YOUR BUSINESS.
, -
41'CHECKORGANIZATIONTYPE:
o INDIVIDUAL 0 PARTNERSHIP
DO YOU SELL THESE VEHICLE TYPES?
..,/ I IF CORPORATION. UST THE $TATE UNDER WHOSE LAW BUSINESS IS INCORPORATED:
.J.IQ CORPORATION OR~ 6-oN
5 MOBILE HOMES
MOTOR HOMES
CAMPERS
[if YES D NO
DYES 0 NO
DYES 0' NO
TRAVEL TRAILERS
MOTORCYCLESIMOPEDS
CLASS I ATVS
DYES [3'" NO
DYES 0 NO
DYES B""NO
D YES ~O
SNOWMOBILES
DO YOU REBUILD
VEHICLES?
DYES G1 NO
6 1 ARE YOU A FRANCHISED DEALER? 0 YES Ii2I' NO I'F "YES," NAME THE MAKE(S),
I LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS:
71 NAME 1/ 'f)' TITLE () d ~ RESIDENCE TELEPHONE '
nathLeen 7 {J.o/e- rr~61 '~nr __ (5'"d3) 7</7-~O/;/
81 RESIDENGEADDRESS -,... ."' ' CITY... . {' -/ A STATI!.)'" ZIPCODEq,,/ -1.7 7
5/ tJ .1',.-<i vv ~r .cJ,pr/J""JI e. (J v '--' v.
91 NAME /' '-r- -T r TITLE' ..s n., ~ D~ 1 R~SIDEI'lCETELEPHONE .1
CTC-'t^JI-r.)f" .'LII./'"S" ".L.- _ lli31 7-17,.qQ.,,{)
10 IRESIOENCEADD?~q.5:' ('_^e~k. .<d- CI~~;,.."t,,?, f\ _ STAJJI<?, ZIPCODE%:f3/.Q7i/77
11 I NAME < , J"''' I TITLE 'D. _'_ 1 J "'" DA R,ESIDEI'lCE TELEPHO~E J
.~T A-n (l,( I I I GI {l P _ J..;:()2L1 0 J Jo .... . ~'>:l!.~ )~I/. 7' ..:J.1"l(.
12 1 RESIDENCE ADDRESS , - (;(. CITY L r I' I STATE At, " ZIP CODE '7
~{(' ~. ~ oS't -->,pr,f1t1t!.p _[I c.;,/~ Q7L/'7
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.
I
141 ADDRESS,CITY,STATE,ZIPCODE .( " r. Id A\.n q ~IGNATURE I
510 -5. Stf....g -.Jf'rtIl9i/e ,<YIC- 1477 X
I AGREEM ENT TO ACT AS AGENT' Any dealer who wants to be designated as an Agent 01 the Divisio .ust sign this agreement By law, all snowmobile llfld Class I "TV dealers musl I
. act as 89ents and must S'2" this 80reemenl.
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
i REPRESENTATIONS IN EXCESS OR IN CONTRAVENTION OF AGENT'S AUTHORITY. AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION.
1sllGNATYRE , tJITLE> /7 {-" ~TJI '1 . . I
.) -;;;"'/U',_._.," /~h..-ft...f:'.~ r r/-C~d.,~~ Ae'M"'r-d;;/7K
APPrlOVAL: I CERTIFY THAT THE LocAtlm(SPECIFIED ABOVE COMPLIES
16 WIT~ ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE
o CITY 0 COUNTY OF
31 NAME
1 -Ka. 1tILee.n
fhtA.(lJe.....
I TITLE
P,06,denT
I RESIDENCE TELEPHONE
(503 )'l';>{,;).( '7 I
II 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.
171 NAME _ TITLE
h2..r.j.~'1 ~_,.Ut:> I .. \::X".U ,coW, ;~ Lll \
181 SIGNATURE 13 \ T" ~ l\ _ DATE
~ '. .,~~ tDIU/bE'
I I) l) fA;PROVEnooo" um,
\ APPROV~ED THE BILLING LIST MUST BE SUBMITTED WITH YOUR RENEWAL APPLICATION
'CIft"'M URE BOND WITH ALL REQUIRED SIGNATURES AND FEES TO:
NIT, 1905 LANA AVE. NE, SALEM, OR 97314-2350
Produeedby
STATEPR1NTlNQ
735.370 (5.88)
BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE)
-$96.S0
11.3 ..31&,
LJo ,/J/)
I <JO-lfD
ADDITIONAL LOCATIONS _ @ $jQ,OO EACH
(SEE ATTACHED SUPPLEMENTAL APPLlCA TIONSL
I ,33;). 3
ADDITIONAL PLATES @ ~EACH _L ,'~.:J"
TOTAL: $
II,,~. J, ~
* IFTHIS IS A RENEWAL OF AN EXISTING CERTIFICATE, USE THE
ATTACHED BILLING LIST TO CALCULATE PLATE FEES.
/W<'>~~
.
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OREGON - T W
MOTOR ~
'lEHlCLES
DIVI:;:; l- j
."... _ JVL.-
SUPPLEMENTAL DEALER/REBUILDER BUSINESS CERTIFICATE
APPLlCA liON
CERTIFICATE NO:
NOTES: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE DELAY
PLEASE TYPE OR PRINT LEGIBLY WITH INK
ALL SUPPLEMENTAL LOCATIONS MUST OPERATE UNDER THE SAME
OWNERSHIP AND BUSINESS NAME AS SHOWN ON THE CURRENT
CERTIFICATE
NAME(CORPORATlONAND/ORASSU~~DBUSINESSJ~ME) L' r BUSINESS TELEPHONE
1 &rlAT'ltje_:,-re/?.f( l/llbtJe JlI-Ilnl.:5m,.Mf ;I,T/JVti..:DYC- ?J./'-d.J1/
SUPPLEMENTAL L1~'1ATION (STREET AND NUMBER) CITY ~, ZIP COOE COUNTY
2 ! 13 'C #; C,/'WCcAj q CIA!, t= tAt! e-J/le- 91 t./ IJ d... L;tJ- AI ~
MAILING ADDRESS ' CITY ~ StATE ZIPCQDE
3 MAl?~1:.,Jj!i1lUa~~' ~(.(3etJe..-' ~~ilf) q'71./ tJ d-.
_4.;so~4 mJl:LA/ .,j. .:5~ncrfte:IJ ,((}/C.€.-tjOI'] Q7'17,f.
'~~I:;" T~~~~. .~~~~~~c~M;=T e;:;:~~~~~~I~~~SR~:R~~L~~:~~~/:~~~~ ~'RL ~~:~~~~T~~:lg~~H~~r:~:~~~:~~ ~~
ESTABLISHED AT THE LOCATION GIVEN.
1 NAME 1 TITLE 1 RESIDENCE TELEPHONE
5 1!7./J-tJI(' I<d. fh/e.e./7 In. ' "PrM tdt!.id- / (6'aJ) ?4.7.~6 I
ADDR ESS,CITY ,STATE,ZIP CODE 1 SIGN~E .. . /f
6 511l~. S;T)..., .-5.pN~4/',e.ld (p. q?lI-77 x' ~_~/J1. /?;1~
. ~ APPROVAL: I CERTIFY THAT THE LOCATION SPECIFIED ABOVE COMPLlES- 10 -iCERTIFYn; TSURETY BOND NO, . Y
, ,I; WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE WILL COVER THE BUSINESS OPERATION AS SUPPLEMENTED ABOVE.
7 D CITY D COUNTY OF
II 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 NAME TITLE 111
8 W"i1fl7^r ~. M.o7"T 't:>W; ~ ~/I.) SIGNATURE OF SURETY/REPRESENTATIVE
91 ~G~~VJJ~' ~/~ 112 TITLE
, c..5 (5 ~CESTAMPORSEALHERE)
(PLACE SURETY SEAL HERE)
DATE
FEE: $3000
SUBMIT APPLICATION WITH ALL REQUIRED SIGNATURES AND FEES TO:
BUSINESS LICENSING UNIT
1905 LANA AVE. NE
SALEM OR 97314-2350
"'''c .,......,.........
OREGON - T W
"'OTOR
VEHICLES ~ II
DIVISION
-
-
IrJU_
.
.
~
SUPPLEMENTAL DEALER/REBUILDER BUSINESS CERTIFICATE
APPLICATION
CERTIFICATE NO:
NOTES: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE DELAY
PLEASE TYPE OR PRINT LEGIBLY WITH INK
ALL SUPPLEMENTAL LOCATIONS MUST OPERATE UNDER THE SAME
OWNERSHIP AND BUSINESS NAME AS SHOWN ON THE CURRENT
CERTIFICATE
NAME (CORPORATION AND/OR ASSUMED BUSINr!}S NAME)
1 Gl',~~j4.;jefn...MJ.l? ti(kYI....
SUPPLEMENTAL lOCATION (STREET AND NUMBER)
2 J 7 3 ~ J.{ /~,,M:t" q.!LJv'. E u Pi~ 1\.>0-
MAILING ADDRESS J CITY V
3 r""~5 I:fr~.t..'NQ.;J- qu..J, lEu~el'f...)o.. c;lr-e~ Cj 7 Va:l...
MAIN BUSlNESSlOCA"'ON_ -"', - f V V ~
4/50 ;;P-I /'Y'Ja.., h" ':D. 5 0 Y J l"Ja -h 'eJ' C) r -e9! C.-1- 97 Y '} If' _
l I (:ERTIFY THAT_LAM_THE-APPLICANT OR AN ALTHORIZED REPRESENTATIVE AND THAT AClINFORMATION 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.
5:<./0 ~ LJS~n9~,1 :+nc
CITY ZIP CODE
q 7 'fa')..
STATE
BUSINESS TELEPHONE
'7;J.&, -~171
COUNTY
L<r..."~
ZIP CODE
I NAME 1 TITLE I""'. 1 RESIDENCE TELEPHONE
5 M!?----:oI1." l<_C<.--H.I.R-P"" f'YI Pre Sid er1t / (503)7 ,,/7-i;1,d,/
ADDRESS, CllTY,STATE,ZIPCODE , I SIGN~U~Y
6 -5/tJ :5 f' J f~J, 5P.llf1fr;tj,:.-()~ Cf7 tJ 771 x ~ a;d {'!.: J 'ZzJ. 72J-~4
APPROVAL: I CERTIFY THAT THE LOCATION sptCIFIED ABove COMPLIES 10 ICERTIFYTHAT'SURETYBONDNO. /"
WITH All LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE Will COVER THE BUSINESS OPERATION AS SUPPLEMENTED ABOVE,
7 0 CITY 0 COUNTY OF
I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS
EVIDENCE OF SUCH AUTHORITY 00 AFFIX HEREON THE SEAL OR STAMP OF
THE CITY OR COUNTY.
NAME TITLE
(PLACE SURETY SEAL HERE)
't:>~_ CDplL ~kl
DATE
M~/61!!>
111
112
TITLE
DATE
8 c..Offt!6fX' "':7.~-rr
9 ~~A~.'w:iJr.
~ 0 . I;LACE STAMP OR SEAL HERE)
SIGNATURE OF SURETY/REPRESENTATIVE
I APPROVED
em- OF SPRINGFIElD
I
FEE: $3000
SUBMIT APPLICATION WITH ALL REQUIRED SIGNATURES AND FEES TO:
BUSINESS LICENSING UNIT
1905 LANA AVE. NE
SALEM OR 97314-2350
735-372 (9-87)
,".--. -