HomeMy WebLinkAboutApplication APPLICANT 11/15/2010
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APPLICATION FOR
THREE YEAR VEHICLE DEALER CERTIFICATE
AS A DEALER OR REBUllDER OF VEHICLES
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~,c; ;1;'T~ST!,!.~;g~.:re_:0M_::_J,~;:: ',I:~P.11J~T!~N.Ef'T~i,f}!~;;,~W, DEALER NUMBER
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o ORIGINAL
o RENEWAL
g,USTOMER ~UMB~R':~'~n
If th'ls is a renewal, do not complete the fee information. Use the attached
billing list to calcuiate your fees. The billing list MUST be submitted with your
renewal application.
Original Certificate (Includes one plate).................................
Additional locations @$230.00 .....................
(Supplemental Application Form 735.372 required for each location)
Additional plates @$54.00 ..............................
$1,012.00
$
I TOTAL -$
BUSINESS NAME AND ADDRESS An a//eratlonofLine3voldsloca/iona rova/.
LEGAL NAME OF APPLICANT (OWNER, PARTNERSHIP, LLC OR CORPORATION NAME) OREGON REGISTRY NUMBER (IF LLC OR CORPORATION)
t>vY\ Ie 're.d-O\W1Vv1C LL I j 0'-5-1(;
BUSINESS NAME (IF ASSUMED BUSINESS NAME, FILL IN REGISTRY NO.) OREGON REGISTRY NO. BUSINESS TELEPHONE
.,..,~ <\'Y'ICvtl I . O-"166L/1 ::n./J, /c':6f,
MAIN BUSINESS LO TlON (STREET AND NUMBER) CITY, (' I ZIP CODE COUNTY
3 ;U;; 00 rt\~ '\ <,=;-1--. 'Sv;~e... S-pn "8 h "-IV\.
MAILING ADDRESS CITY'
4 ? DO 1Vl,-,\i'\ J-. SVI k. S ~(l' t..../UtA.
TYPE OF OPERATION
5 CHECK ORGANIZATION TYPE: 0 Individual.
6 II we primarily sell: 0 New Vehicles
7 II we are a franchise dealer:
8
1
2
~
II we sell NEW RECREATIONAL VEHICLES: 0 Yes
IF "YES," SERVICE FACILITY LOCATION (STREET AND NUM~ER) CITY
o Partnership
Used Vehicles
Yes C& No
~ No
llC
If corporation, lisl the stale under
O which business Is incorporated:
Corporation: '
If "Yes," name the makes>
ZIP CODE
LOCATION APPROVAL (II renewal, required only II dealer is changing business location)
Certification of Local Zoning and Business Regulatory Compliance. ORS 822.005 requires a vehicle dealer license, unless exempt
under ORS 822.015, lor any person who:
(a) Buys, sells, brokers, trades or exchanges vehicles either outright or by means of any conditional sale, baifment, 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 or 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 01 the activities listed in (a) through (c) above under your ordinances, at the location of the
business given on Line 3. Pursuant to ORS 822.025(6)(b)(A)(B), applicant meets requirements below.
9
10
PRI
As the zoning official for the locality in which this business Is located, I venfy by my signature below that the location of this business as stated on this application,
complies with any land use ordinances and business regulatory ordinancas of the city or county, as appropriate pursuant to ORS 822.025,6(a)
T(':!;.EPH01NE)NuMeER . _ l?O I
o COUNTY OF: ::>
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Date Received:
NOV 1 5 2010
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PRINCIPAL'S DEALER HISTORY
12
Information on the principals of this business is requested under Oregon Revised Statutes (ORS) 822.035 and Oregon
Administrative Rule (OAR) 735-150-0024.
OAR 735-150-0010(15) defines the principal of a dealership as any person who controls or manages the business
organization, the employees, or the agents of the business organization. "Principal" includes all owners, partners,
members, corporate officers, managers, directors, et al.
Please provide the following Information about all owners listed on this application and other prlnclpal(s) of
the business: I
Has any principal of this dealership been financially or operation'ally involved in any Jurisdiction, including Oregon,
with a vehicle dealership whose license or right to apply for a license was revoked or is currently suspended?
~NO 0 YES, revoked currently suspended. If "YES," complete Section 13.
13 NAME OF DEALERSHIP
DEALER LICENSE NUMBER
PRJNCIPAL'S NAME
STATE WHERE SUSPENDED I REVOKED DATE OF SUSPENSION I REVOCATION EXPIRATION OF SUSPENSION
14
Have you ever been an owner or principal on a vehicle dealer license in Oregon (excluding current application)?
~NO 0 YES: If "YES," complete Section 15.
NAME OF DEALERSHIP
PRINCIPAL'S NAME
15
DEALER LlCENSE NUMBER
OWNER INFORMATION AND CERTIFICATION
False certification is a Class B misdemeanor under ORS 162.085 and is punishable by six months in jail, a fine of up to
$1,000 or both. In addition, civil penalties and DMV sanctions against you or your dealer certificate may be imposed.
Wjjh this in mind.. .
.
.
.
.
I CERTIFY. . .
. I am the owner, a partner, limited liability company member or corporate officer of this dealership and my name is
listed on this application.
ALL information on this application is accurate and complete.
I deal in vehicles ahd oonduct business at the location given on Line 3 of this application.
The dealership will comply with all applicable laws and administrative rules.
I/we hereby certify that the persons named in this application are not acting as the alter ego, in the place of, or on
behalf of, any other person or persons in seeking this license.
BUSINESS LOCATION INFORMATION:
Property is (check one): 0 OWNED ~ LEASED / RENTED:
If property is "Leased I Rented" complete the following:
LEASE OR RENTAL PERIOD: ..1
~L
'f
CITY~
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PROPERTY OWNER'S FULL NAME
e V
PROPERTY OWNER'S ADDRESS
.3 If'1 sr /",'11 0{v,
DMV AGENT AGREEMENT
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/
The dealer is granted the following options as a DMV agent and must comply with all applicable laws and administrative
rules. The dealer is not obligated to perlorm any of theSe options except as required by law. * Snowmobile dealers
must act as DMV agents for Oregon residents.
· * Accept applications and fees for titles and registrations of vehicles they sell, and only charge fee amounts set by
Oregon Revised Statutes and Oregon Administrative Rules.
. Perlorm vehicie identification number inspections on vehicles they sell, except a dealer may not perlorm an
inspection under those situations described in OAR 735-22.
. Issue temporary registration permits for unregistered vehicles they sell.
. Agent status can be placed on probation, suspension or revoked as allowed in Oregon J\d!!!i~~t~Mll(fed:
735-150-0120 for non-compliance of any Oregon Revised Statute of the Oregon Vehicle~~.
. By signing this application on Page 3, the dealer becomes an agent of DMV and agrees to comply with all
administrative rules and all dealer reiated statutes in the Oregon Vehicle Code. NOV 1 5 2010
Page 2
Original Submittal
03/19/03 WED 10:17 FAX 541686795i
EUGENE FIELD OFFICE
I@002
JiDlI'
R QUEST FOR DMV LOC TION
REQUIREMENT EXEMPTION
(OAR 735-150-0030)
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DEALER CE;RTIFIc.A TE II
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Complete (please print or type) and submit to DMV Business Regulation, 1905 Lana Ave NE, Salem
OR 97314. '
A DMV Investigator will review your request. If approved, a signed copy ofthe request will be
retumed to you. You must keep the' signed copy on hand at your business location. Failure to do so
may subject you to a ciyil penalty or administrative sanction.
This exemption is valid only for the dealer certificate number and location listed. A new exemption,
must be applied for if there is a change in name, address or dealer certificate number.
::'1;;:;,.:;.' , ," ':', kSECTIO~ 1.~]NAMEAND LOCATION OF,DEALER BUSINESS:', "'~',~<_,-{,).< 'i;~ :.~.
NAME OF DEALERSHIP
f'e.,~\<YlL/'nL~
ST EEl" ADDRESS (BUSINESS LOCATION)' A
, Co 0 C VV'lCA.l f\ SK.QQ.. r Sv,'+e.. IT
CITY " I
<;f'\I 1\';) hQ..{~
Any dealer wanting an exemption from all or part of the requirements in (a) through (c) below MUST
check the appropriate box(es) below and provide a clear arid complete reason for the request.
Pursuant to OAR 735-150-0030 (2), I am requesting an exemption from the requirement(s)
listed below: ,', ' ' ,
tR((a) Have sufficient space to display one o~ more vehicles of the type the dealer has been
issued a certificate to sell.
reason: JJ() VlO.t \;vl-sh -to .J;..y~ \ie.J,:e.ks , \!Q..~kl{
,
o~ VVI..e.( \., VY'\ ; L ") I 'j e.. '^ \JQ. \,~ c./ qh bL ~() I J \) I" .......
8--UC\-\Di'D'\ \(\~Y1~J--ovdj 1
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whuJe~o..l
o (b) Provide a means for the public to contact the dealer or an employee of the dealer at all
times during the dealer's normal business hours.
reason:
Date RA~Ah/Arl'
NO',' 1 5 2910
OriginalOublllillo!l1
"-~J,.",=,.F';II;i:!li"..t1il
(CONTINUED ON NEXT PAGE)
03/19/03 WED 10:18 FAX 5416 "951
EUGENE FIELD OFFIC
I4i 003
(c) Have displayed an. exterior sign permanently affixed to the land or a building which
identifies the dealership by the name shown on the dealer's business certificate.
reason: l~~ ( D,-,\1 \cs 'f'Q...~--c.,..)\{YLL",'l( cJ ufiL <>\... II\l1~L~u..M; L<)
c; \it () P c.---..,J..) cJ V VI 0 ~ l ).)1;:' \.-... +u in e- C>--o/I. kJ--oJo..u J ~r.
lr'lL iA' I ~\--. t--u 0 b~; l\ tJ... J!Lu-l.e..i \, ,"-0n~.(~ 0 vd j t-c
~-' I C ~/y ') 112-tj u....11), l,VL 0'0 1-uJ' II\. thrvuJ ft., \f\.\e.t~ <:<3
J:Q.cVl" (;r c~ IAIC......v\<. ,e..lo.J--<J. .J-u 0u( hu-;.iYlu'J
I 0
NOTE: If your request for an exemption is based on a zoning requirement, you MUST attach to this
form a letter or other evidence from the appropriate zoning authority which specifically and clearly
supports your request for exemption.
I . ",. .-. :~..' -.'.""". ".....,.. .,.....SIGNATURE..O" ,; ,"'." ...:,.;.....).c... -: . ......~:
_ ~___.._~_ ._.~.,___________;. .~_~ ~___.. _. _ _ _. "e\~ '.: ~_'.f'-.. - . -. _' ~. . '" '. '. -. :." ., -'" .'~
I certify that I am the owner, a partner. a member of LLC or a corporate officer of this dealership. I
understand that Oregon Administrative Rules require a dealer business location to comply with each
of the three conditions listed above. However. the business location of this dealership, as shown in
Section 1, is unable to meet the requirements. An explanation of why an exemption is necessary is
given in Section 2. Based on this expianation, I hereby request the exemptions marked in Section 2.
Note:
This exemption does not constitute a variance on state, county or city land-use restrictions or laws.
Violation of zoning laws/restrictions could result in cancellation of your dealer's license.
PRINTED NAME OF PERSON SIGNING nus FORM TITLE .
jVl;c h<A.e... ( LLL Wl.(U'II1f:,e:r
SIGNA1lJRE DATE
X ' II Cj /0
An exemption is granted for items in Section 2: (a) {b)O (6)0
(Investigator to check all applicable boxes). If applicable, the dealer must comply with the following
resonable altematives:
PatE' Rf':!~Fiived:
N(}V-4-H919
ungmal suu,"jl~.!>:
PFiINTED NAAlE OF 1'N.\tESTIG1IPR r MANA.'GE'A
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jNVESnGATClFI"f1~l"AGER' S J(rlJRE
X. . JO'<""". .~ ~
TITLE
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PATE
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