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Home My WebLink AboutBusiness License License 1987-11-17 -~ ~- ~ APPLlCATII FOR TYPE I BUSINESS Cii.T1F1CATE ~ AS A DEALER OR REBUILDER OF VEHICLES. 0 ORIGINAL Q RENEWAL * NOTE: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY PLEASE TYPE OR PRINT LEGIBLY WITH INK CERTIFICATE NO: I NAME (CORPORATION AND/DR ASSUMED BUSINESS NAME) BUSINESS TELEPHONE 1 Great Western Mobile Homes, Sales &, Listings, Inc. (503}726-2171 21 MAIN BUSINESS LOCATION (STREET AND NUMBER) CITY ZIP CODE COUNTY 5024 Main Springfield 97478 Lane I MAILING ADDRESS CITY STATE ZIP CODE 3 5024 Main Springfield 97478 Lane 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 D INDIVIDUAL D PARTNERSHIP KiI: CORPORATION Oregon 00 YOU SELL THESE VEHICLE TYPES? 6 I ARE YOU A FRANCHISED DEALER? DYES IiQC NO I LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS 71 NAME TITLE '~H RESIDENCETELEPHONE Kathleen M. Maple President ~ (503) 747-2061 81 RESIDEN<sJ.-'6'DRE~. 5th CITYSpringfield sOfJqon ZIP47'S'h 9 I NAME TITLE. D~ RESI8~NCEJEWO_P9HQN4E. , George T. Travess ~ec.-Treas ~ I~ 3) 747. 9 ~ 10 I RESIDE~~D~fi~ek C1TYspringfield SO~TJgon ZIP~477 111 NAME Stanley A. Maole TITLBoard of Dl'r D~TE H RFSIDENCETELEPHONE .. \ SQ;!) 747-2061 12 I RESIDENCE ADDRESS CITY ST E ZIP CODE . 510 s. 5th ,C::or;nnfip1n f"lr"",'JI'l q7477 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 1 George T. Travess Secretary/Treasurer 141 ADDRESS,CITY,STATE,ZIPCODE lSIGNATURE 1495 Cheek, Springfield, Oregon 97477 X I AGREEMENT TO ACT AS AGENT: (YOU MUST SIGN THIS AGREEMENT IF YOU SELL SNOWMOBILES OR CLASS I A TV'S) I I (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE MOTOR VEHICLES DIVISION. I (WE) AGREE TO COMPLY WITH ALL APPLICABLE 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. 15 ~GNATURE I TITLE I DATE 5 MOBILE HOMES MOTOR HOMES CAMPERS IiU YES D NO DYES jQg NO DYES !Q9 NO TRAVEL TRAILERS, MOTORCYCLEIMOPEDS CLASS I A TVS 16 APPROVAL: I CERTIFY THAT THE LOCATION SPECIFIED ABOVE COMPLIES WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE o CITY 0 COUNTYOF 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. 1 71 NAME TITLE "".~-'( ~. Mr>T'T '~. ~ .e.n<..uoL'> 181 ~:u:mJ \,~ DATE . V\AW"o. , l\A "7/ 2!-7 I () -ARt! RO\\f])lSEAL HERE) , tl I - .. .. !J I f. ~ , Jt,. D YES !Xl NO o YES [Xl NO DYES [jg NO SNOWMOBILES DO YOU REBUILD VEHICLES? D YES !XiI: NO D YES ~ NO jlF "YES", NAME THE MAKE(S): I RESIDENCE TELEPHONE ( 503 } 747-9940 BUSINESS CERTIFICATE FEE (INCLUDES DNE PLA TEl $96.00 ADDITIONAL LOCATIONS @ $30,00 EACH (SEE A IT ACHED SUPPLEMENTAL APPLlCA lIONS) ADDITIONAL PLATES @ $11.00 EACH TOTAl. $ I * IF THIS IS A RENEWAL OF AN EXISTING CERTIFICATE USE THE ATTACHED BILLING LIST TO CALCULATE PLATE FEES. THE BILLING LIST MUST BE SUBMI1TED WITH YOUR RENEWAL APPLICATION BOND WITH ALL REQUIRED SIGNATURES AND FEES TO: BUSINESS liCENSING UNIT, 1905 LANA AVE. NE; SALEM;OR9~314-2350 735-370 (9.87) ASA ~';'T ~/th'N MOBILE HOME SALES & LISTINGS. INC. pre-owned mobile hom8$ our specialty 5024 Main Street Springfield, Oregon 97479 'ICATE Bu.. (S031 726.217. R... IS031 747.206 AND ATV'S) ....,~ NOTES: FAILURE TO ACCURATEL PLEASE TYPE OR PRINT I DO NOT SUBMIT APPLICI I I-Jr:rIJC D GJ RENEWAL * ~rn[U]v ORIGINAL :nAN MAPLE SoJy I NAME (CORPORATION AND/OR ASSL BUSINESS TELEPHONE Great Western Mob Own.. . Manag., . (503) 726-2171 I MAIN BUSINESS LOCATION (STREET .. ,. .. '__ , DE COUNTY 2 ~024 Main Sprinqfield 97478 Lane I MAILING ADDRESS CITY STATE I ZIP CODE 3 5024 Main Sprinqfield Oreqon 97478 LIST THE ADDRESSES OF ALL ADDITIONAL BUSINESS LOCATIONS, A SEPARATE APPLICATION (FORM 371) MUST BE COMPLETED FOR ANY ADDITIONAL LOCATIONS IN A DIFFERENT CITY OR COUNTY, 4 I STREET ADDRESS I CITY ZIP CODE I COUNTY I TELEPHONE 5 I STREET ADDRESS I CITY ZIP CODE I COUNTY I TELEPHONE I CHECK ORGANIZATION TYPE: I'F CORPORATION, LIST THE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED 6 0 INDIVIDUAL 0 PARTNERSHIP IiU CORPORATION Oreqon 7 I CERTIFICATE NO' LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS I NAME I TITLE I DATE OF BIRTH I RESIDENCE TELEPHONE 8 Stanley A. Maole Prp"ir'!ent {50;1 747-2061 I RESIDENCE ADDRESS I CITY I STATE I ZIP CODE 9 510 S. 5th St. __ Springfi:.ld Ore 97477 10 I N~~hleen M. Maple ITIT~~cretaryl.iiiirl~~S~D;~CET~~;~N;~~ RESIDENCE ADDRESS I CITY I STATE ZIP CODE 11 510 S. 5th St. ~rinqfield Ore 97477 NAME ITITLE - I DATE OF BIRTH RESIDENCE TELEPHONE 12 G. Terrence Travess Vice-President {503t 747-9940 I RESIDENCE ADDRESS I CITY I STATE I ZIPCODE 13 1495 Cheek Springfield Ore 97477 14 ARE YOU A FRANCHISED DEALER? 0 YES I'F YES, NAME THE MAKE(S): IIB'CHECK IF YOU SELL MOBILE HOMES Kl NO JJ.CHECK IF YOU REBUILD VEHICLES I CERTIFY THAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTATIVE AND THAT ALL INFORMATION ON THIS APPLICATION IS 15 ACCURATE AND TRUE. I CERTIFY THAT THE BUSINESS DOES OR WILL DEAL IN, OR REBUILDS VEHICLES AND IS OR WILL BE ESTABLISHED AT THE LOCATlON(S) GIVEN. I NAME I TITLE I RESIDENCE TELEPHONE 16 Stanley A. Maple President ~t (503) 747-2061 I ADDRESS. CITY, STATE, ZIP CODE I SIG~~r /J . 17 '510 S. 5th St., SorinQfield, Ore 97478 X -'.clh./rvK-'-1 fA ~ AGREEMENT TO ACT AS AGENT: I (WE) WISH TO BE DESIGNATED AS A LIMITED AGENT FOR THE Mo'[6~ VEHICLES DIVISION. I (WE) AGREE TO COMPLY WITH ALL APPLICABLE LAWS AND ADMINISTRATIVE RULES AND AGREE TO HOLD THE Eii9iSION HARMLESS OF ANY LOSS OR 18 EXPENSE RESULTING FROM ANY ACTS OR REPRESENTATIONS IN EXCESS OR IN CONTRAVENTJON OF AGENT'S AUTHORITY, AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION. ~IGNAT , . I TITLE I DATE 19 C. /';JY) a:& . President L RO AL: I CERTIFY TIlAT EACH LOCATION SPEelFIED ABOVE COMPLIES - - , WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) $96.00 20 !ll:I CITY '1 COUNTY OF ' S p r i n q fie 1 d ADDITIONALLOCA TIONS @ $30,00 EACH I CERTIFY THAT I AM AUTHORIZED TO SIGN THIS APPLICATION AND AS 21 EVIDENCE OF SUCH AUTHORITY DO AFFIX HEREON THE SEAL OR STAMP OF THE CITY OR COUNTY. ADDITIONAL PLATES ~ $11.00 EACH 22 I NAME mLE ~ ~. M.~"!T ~. Coc>OIt. -.l.l I SIGNATURE DATE 23 I A~~~rJ1j' ORSEALHER~~"l/~1t:> 735-370 (4-66) ;; <jl ;,,1 ;';-'" ;~. 'CWTY ^ '.;''':" G vF Sr~JNGFH!tr) TOTA' ' $ * IF THIS IS A RENEWAL.O. F AN EXISTING CERTIFICATE USE TH;'] ATTACHED BILLING LIST TO CALCULATE PLATE FEES.