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Home My WebLink AboutMiscellaneous License 1989-12-11 . '. .' .,: .' : " ~.' PAGE TWO APPLICATION FOR TYPE I BUSINESS CERTIFICATE o ORIGINAL 8ReNEWAL * ts.._...._ol_l AS A DEALER OR REBUILDER OF VEHICLES NOTE: PlEAS! READ INSTRUCTIONS ON PAGE ONE BEFORE COMPLETINO THIS FORM. FAILURE TO ACCURA TEL Y COMPLETE THIS FORM WilL CAUSE UNA VOIDABlE DELAY. PlEASE TYPE! OR PRINT LEQ1Bl Y WITH INK. 1 ~NAME(CORPORATI9r AN~/OR ASSUMED aUSINESSNAME) .@.u[ A'~~o;l;',",,, 2 "'/\IN BUSINES!; LOCATION (STREET AND NUMBER) 3';-1'1 ~hJ"'A 31MAJLlNOAODAESS .7'/'71 CERTIFICATE NO: BU$INESSTELEPHONE N/:,'Jfn CITY ZlPCOOE COUNTY .r.,;;",_/~.,.././ I'?Y?J' h_ CITY' STATE ltPCOOE ,;#";h ~!'~~f'/,r,,1?n ""'$?.P A SEPARATE SUPPLEMENTAL APPUC".I'IO~ (FORM 372) MUST BE COMPLETED F IR EACH ADDITIONAL LOCATION FROM WHICH YOU OPERATE YOUR BUSINESS. 41 CHEC~GAHIZATION TYPE: IIFCORPORATION. LIST TliESTATEUNDERWHOSELAW BUSlHESSlSIHCORPORATED: ll3'INOMDUAL 0 PARTNERSHIP 0 CORPORATION 00 YOU SEU. THESE VEHICLE TYPES1 _____- 5 MOBILE HOMES Qy ~ TRAVEL TRAILERS MOTOR HOMES t::r YES 0 NO MOTORCYCLES/MOPEDS CAMPERS lH'YES ONO CLASSIATVS ~ONO ~ ~S ONO l!:tYES ONO CLASS IliA TVS SNOWMOBilES 00 YOU REBUilD VEHICLES? ~ES DYES DYES 6 I ARE YOU A FRANCHISED DEALER? 0 YES (H-""N6 I LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS: 7 NAME ,,7',;!,vq ,;J;wA'....,,,J. TiTlE #.4;;';""" Ot~E.r.l-IRJ-~ jE~~;,'fEJ;J~~;'i-., 8 _RESIDi~E~O.e~ 7""",,~r,... AI.,.;' CITY S:~~- ~O- zl~1i~__ 9 NAME - n --- trtLe"'-- OATEOF81RTH Rfs'~TELEPHONE' 10 I RESlOWCEADDRESS _ CITY STATE ZlPCC/OE _ ___ 11 I NAME TITLE OA,TEOF81RTH RfSlQ[~ETElEPHO/<oIE 12IRESlDE~E_~~RESS .___ 10TV_._____ _STATE _niIPCOOl: __ .__= II CERTIFY TKAT I AM THE APPLICANT OR AN AUTHORIZED REPRESENTAnVE AND THAT AllINFORMAnON ON THIS APPUCAnON IS ACCURATE AND TRUE. I CERnFY THAT THE BUSINESS DOES OR WILL DEAL IN VEHICLES. OR REBUilDS VEHICleS AND IS OR W1lllU! ESTABLISHED AT THe lOCATION GIVEN, 31 NAME t?) 1 TITLE 1 RESIDEHCETELEPtlONE 1 /1"" .4h.AY/~?/",/1;M"io A......!'. (S-P..,) ?~~-.7-'.r7 14jADDAESS.CITy.91'A,TE.ZIPCODE ISIGNA,TURE ?"I! <,,-,.tt-, // ~"r /I, ""-~"/r X ~ _H' AGREEMENT TO ACT AS AGENT: :r.......-:..":':...~.:.~.;_::.';"'..::::t>_.....,~-;..,......._.......,...,V_..-.....,V I (WE) WISH TO BE DESIGNATED AS A llMIT"ED AGENT FOR THE MOTOR VEHICLES DIYlSION, I (WE1 AGREE TO COMPlY WITH ALL APPliCABLE LAWS AND ADMINISTRATIVE RULES AND AGREE TO HOlD THE DIVISION KARMlESS Of ANY lOSS OR EXPENSE RESUl TlNQ FADM ANT ACTS OR REPRESENT A noNS IN EXCESS OR IN CONTRAVENTION OF AGENTS AUTHORITY. AND FROM INCIDENTAL EXPENSES DUE TO TERMlHA lION. 5 SIGNATURE d"'? I nnE I "''' 1 X -?:;, -::;? __. ./ ,.,<;- /2' h/~ :OCATlON ~ CERTIFY THAT mE lOCATION Sl'EClflEO A1- 16 COMPUES WITH AU. LAND USE Ofl BUSINESS REGULATORY ORDINANCES BlISlNESSCERTlFlCATEfEE(lNCLUDESONEPlATEl 0"'" fliJ CITY 0 COUNTIOF ooi..nqhJd II CERTIFY THAT I AM AUTHORIZED TO SIGN THIS Af>f>UCA TION AND AS I EVIDENCE Of SUCH AUTl-tOAiTY DON'flX HEREON THE SEAt. OR STAMP Of THEClTVOflCOUNTY. 7INA,ME TITLE 1 .r!l"'T1~"" L. AAn.J+ VLJIIVI.i,~)(, 1tUl. S~<nATURE '0 OAT" 18 X\.'r-.\~IQ,01\.l'fI.;rl- 1~'lliq_ I ~'ijl'm!.U"""""" em OF SPRINGFIEW I IF "YES: NAMETHEMAKElS., $96.50 AOOITIONM.lOCATIO~'" II $3ll.00EACH (SEEATTACHEDSUPPl..EMENTM.APPl.lCATIONS) ADOITIONALPLATES 0 $ll.50EACH TOTAL, $ * IF THIS IS A RENEWAL OF AN EXIsnNGCEJlnFlCATE. USE THE I ATTACHED BILLING LIST TO CALCULATE! PLATE FEES. 1~~UNGUSTM_lI.sr~SUBMITTEDWl!HYOURAENEWALA~AT1ON -. ..&,~-,- * ONO I3No Gr;O ~"""'.J, l~rn[U]w APPLlCA Tit FOR TYPE I BUSINESS ClmFICA TE D ORIGINAL ~ RENEWAL * NOTE: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY. (S.. bonom ,,,ht,,,"'.'OI....} PLEASE TYPE OR PRINTLEGIBLY WITH INK. CERTIFICATE NO: Y?t!J 1 I NAME (CORPO~ATION,^ND/Oj!fSSUMED BUSINESS NAME) BUSINESS TELEPHONE ~ t'! l/.> h ((.7;..hTP ~'n. '7-? ~ - ;;u.:u 2 MAIN BUSINESS LOCATION ~STREET AND NUMBER) CITY ZIP CODE COUNTY....". ,,---,z't..n-x!?4;A ~/;~<O'P'';,f''k/ f1?~7! A';",/"vc :MAICiNG'ADDRESS~~ CITY/ . /.. STATE ZIP CODE (39?1 h,,.;,,, '~~ 5'/// t/r. <;??7'?J ~ A SEPAR E SuPPLEMENTAL APPLICJ(""f!ON (FORM 372) MUST BE COMPLETED FOR EACH - . --~ ~Dl'rIONAL LOCATION FROM WHICH YOU OPERATE YOUR BUSINESS. 41 CHEg.oRGANIZATlON TYPE: I IF CORPORATION, LIST THE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED: ~NDIVIDUAL 0 PARTNERSHIP 0 CORPORATION DO YOU SELL THESE VEHICLE TYPES? / 5 MOBILE HOMES g):liS i3" NO MOTOR HOMES [3'" ~ 0 NO CAMPERS BYES 0 NO AS A DEALER OR REBUILDER OF VEHICLES TRAVEL TRAILERS ~5S-::: 0 NO MOTORCYCLES/MOPEDS ~ 0 NO CLASS I ATVS BYES 0 NO SNOWMOBILES ~NO DO YOU REBUILD VEHICLES? DYES B'NO" - ..-- 6 ARE YOU A FRANCHISED DEALER? 0 YES I3""NO IIF "YES," NAMETHE MAKE(S): LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS. PARTNERS OR PRINCIPAL CORPORATE OFFICERS: 7 NAME -tl/lAJ J~II/r;"'.Jf)", 8 I RESIOENCJi.AOORESS -r L ... z.y-)~ LPf/'.fLI;' 9 I NAME 1 0 I RESIDENCE ADDRESS 11 I NAME 1 2 RESIDENCE ADDRESS /1./ TITLE /l c//uh,,>, CITY ._---~~!/-"'# TITLE DIiliiIlIIii- STATE #, DATE OF BIRTH RESIDENCE TELEPHONE ($";1. ?Jc, - 7/131 ZIP COOE 9"?~?3 '1SIDE~CE TELEPHONE ZIP CODE CITY STATE ,TITLE CITY DATE OF BIRTH RCSIDE~CE TELEPHONE ZIP CODE STATE 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. 131 NAME /J I TITLE /? I RESIDENCE TELEPHONE A/A,A/ J;.~A-j4S4h ?//Pn/,. (,>,::>3') ??t:-7.J,7'J 141 ADDRESS,ciTY,STATE,ZlPCODE j SIGNATURE ./? 7YS-i? $r//$/~ &" J:-a//?0 ~~17 X ~~;;:i3.- I AGREEMENT TO ACT AS AGENT. Any dealet who~ to.be designated as an Agent 01 the DiviSIOn must sign this egree~w. all Snowmobile and Class I ATV dealers must . act as aQents and must sIan this aQreement. II (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 AGENrS AUTHORITY. AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION. 1 5 SIGNATURE A . I TITLE I DATE X /'Y .<2.".~ ____ / H''''P} dP - /7- ~y APPROVAL: I eef!ifiFY THAT THE LOCATION SPECIFIED ABOVE COMPLIES $96.50 1 6 WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) o 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 ADDITIONAL LOCATIONS ~ $30.00 EACH (SEE ATTACHED SUPPLEMENTAL APPLICATIONS) ADDITIONAL PLATES @ $11.50 EACH 17 0.~(-;12-'T" <S. ~i'''''' =....)_CDoeLAt-.M.. , 8 SIGNATURE (.., t. ~.J--. . .' DATE 1 X~' ?).;/.\~. --...,.. 't2iJ?)JF';>F. j,*IFTHISISARE.NEWALOFANEXISTINGCERTIFICATE,USETHE I i .') I ATTACHED BILLING LIST TO CALCULATE PLATE FEES. e t (PLACESTAMPORSEALHEREl - ; THE BILLING LIST MUST BE SUBMITTED WITH YOUR RENEWAL APPLICATION Iic'~lnr.KM}If;MT.Al'P.lJ,CATJPN A SURETY BOND WITH ;'LL REQUIRED SIGNATURES AND FEES TO: . OtS'KllMjtl~1;Us Lie SING UNIT, 1905 LANA AVE. NE, SALEM, OR 97314-2350 ............ STATE PRINTING TITLE TOTAL: $ 735.370 (5.88) ~~';, ~rnlUJW APPLlC.N FOR TYPE I BUSINES_ERTIFICATE . ASA DEALER OR REBUILDER OFVEHICLP- 0 ORIGINAL ~NEWAL * NOTE: FAILURE TO ACCURATELY COMPLETE THIS FORM WILL CAUSE UNAVOIDABLE DELAY PLEASE TYPE OR PRINT LEGIBLY WITH INK CERTIFICATE NO: 1 I NAME (CORPORATION AND,OR ASSUMED BUSINESS NAME) BUSINESS TELEPHONE ot'!)allf .4;Jt?/np1;vt! 7-<~']?.<'3 21 MAIN BU.SINESS LOCATION (STREET AND NUMBER) CITY ZIP CODE COUNTY :] '1'l'? /fl~;,f SiJ7;,.,., ,,:"/~ t/1,.,;?}' ~//<" I MAILING ADDRESS CITY" ,;' STATE ZIPCQOE 3 J<;'71 /1141/' ,'i~/).:{,J?//k/~, ~-?Y:?.f A SEPARATE SUPPLEMENTAL APPLlCA'nON /FORM 372) MUST BE COMPLETED FOR EACH ADDITIONAL LOCATION FROM WHICH YOU OPERATE YOUR BUSINESS. 4 CHEC9RGANIZATlON TYPE: I IF CORPORATION. LIST THE STATE UNDER WHOSE LAW BUSINESS IS INCORPORATED 0'lNDIVIDUAL D PARTNERSHIP D CORPORATION DO YOU SELL THESE VEHICLE TYPES? 5 MOBILE HOMES MOTOR HOMES CAMPERS g~ 0 [3"YES 0 0YES 0 NO NO NO TRAVEL TRAILERS MOTORCYCLE,MOPEDS CLASS I ATVS ~ES 0 0YES 0 0-YES 0 NO NO NO SNOWMOBILES DO YOU REBUILD VEHICLES? DYES DYES ~ G-NO 61 ARE YOU A FRANCHISED DEALER? 0 YES G-liio I LIST NAME AND RESIDENCE ADDRESS OF ALL INDIVIDUAL OWNERS, PARTNERS OR PRINCIPAL CORPORATE OFFICERS 71 NAME ~c?" 4.IJA"~JP" TITLE /lll'/le/ D~ 8 I RESIDENCE ADDREs/" r ~ / -J ~ / CITY ~ ,j STAT€." IJ'>''> t7 //7,../,/#;.?J.4' ,)/.47- Vd. 91 NAME TITLE'. DATEOFSIRTH RfsIDE~CETElEPHONE 1 0 I RESIDENCE ADDRESS CITY STATE ZIP CODE 11 iNAME TITLE DATE OF BIRTH I RtSIDE'fETELEPHONE 12l RESIDENCE ADDRE~ CITY STATE I ZIP CODE 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. 131 NAME ./? ~ I TITLE . I RESID.ENCETELEPHONE /'./t711 >>,4;AS~ -11'/7e!-1 (.>t?J ) ?.?,(:,pn? 141 ADDRESS,CITY,S E,ZIPCOOE lSIGNATUR~ 'l'f,flJ p/#Z?/~ &:: ,#fi'/"; .p/~)7J' X ~/ - I AGREEMENT TO ACT AS AGENT: (YOU MUS'r'"SIGN THIS AGREEMENT IF YOU SElCSHOwMOBILES OR CLASS I ATV'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 CONTRAVENJION.OF..AGENT'S AUTHORITY, AND FROM INCIDENTAL EXPENSES DUE TO TERMINATION. 15 SIGNATURE (7) /j ~ I TITLE 4. I DATE . .X A'~~ ,'fYPtlh ,/-tf - fJ', APPROVAL~RTlFY THAT THE LOCATION SPECIFIED ABOVE COMPLIES - $96 00 16 WITH ALL LAND USE OR BUSINESS REGULATORY ORDINANCES OF THE BUSINESS CERTIFICATE FEE (INCLUDES ONE PLATE) . o CITY 0 COUNTY OF I'F "YES", NAMETHE MAKE(S): RESIDENCE TELEPHONE ( (P,J) ?.:?v 7 Y.7? ZIP COD'\7'?"~ II 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. 171 NAME TITLE ~..,. MoT T l':i'-U. c.ooc. ~IJ TOTAL: $ 181 SIGN~ATURE ~ DATE I - ---, XU ~ 11 /10 Is-r * IF THIS IS A RENEWAL OF AN EXISTING CERTIFICATE USE THE I \ U I ATTACHED BILLING LIST TO CALCULATE PLATE FEES. (PLACE flWPldWlf' '"~ _ THE BILLING LIST MUST BE SUBMITTED WITH YOUR RENEWAL APPLICATION SUBMI! ,gRI8fr"U11 BO WITH ALL REQUIRED SIGNATUR~S AND FEES TO: BU::.".".... ~Iw'-"w't 05 LANA AVE. NE, SALEM, OR 97314-2350 ADDITIONAL LOCATIONF @ $30.00 EACH (SEE ATTACHED SUPPLEMENTAL APPLICATIONS) ADDITIONAL PLATES @.$11.00EACH 735.370 (9.07)