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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<'>~~ . . 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) ,".--. -