HomeMy WebLinkAboutApplication APPLICANT 5/10/2011
MaY. 6. 2011 8:15AM
No 3153 p. I
IIIDII UPPLEMENTAL
1____ DEALER I REBUILDER VEHICLE
~~~ DEALER CERTIFICATE APPLICATION
. All supplementallQC8tions mllSl operale under the same ownelShlp
and business name as shown on the cummt certificate. (ORS 822.(40)
. Subm~ application with all required signatures and fees 10:
BUSINESS LICENSE UNIT, 1905 Lana Menue NE, Salem OR 97314-2360
. No proof 01 Insurance required
. Any _milan 01 Une 2 yoida location oppnIYlIl.
. Check it 0 New VeI1Ictee 0 U88Cl Ve/l1cte9
DEALER NUMBER
EXPlRATION DATE
EFFECTIVE DATE
FEE: 0 $230
OOTY
EI1.l,(.,ytR...
COONTY
t),s-s-
COOE
97'1tJ3
1
CITY
COUNTY
&TAn: ZIP CODE
3
4 ....._N3%S~ /~. /" fftiLm /,u:S d'6)-,d C77' I
DEALER CERnFICAnON - Must be III neel b the dealer-
Fales certification is a Class B miSdemeanor under ORS 162.085 and is punishable by SiX months In jail, a flne 01 up to $1,000 or
both. In addition, a civil penalty of up 10 $1,000 and DMV sancliOns against you or your deal... oertifK:al9 may be imposed. With the
above penalties in mind, I CERTIFY:
I am the owner, a partner, an LLC member or a corporate ofIIcer of this business and Ihat all information on this appIicalion is
accurate and true. This busin.... deals in "'_, or rebuilds ve~icI9S al the location given. This supplementallocalion will ope(B!e
under the same ownefSh' and business name as shOwn on the current cer!illcale.
PRlNTEC N . )
5 eUIA...
QCNATURI!
6 X
BOND ENDORSEMENT
Place surety Mal here [>
I certify lhat surety bond number.
1UR! OF SUR,ETY/REPRE.9ENT"rwe
will cover the business openrtion as supplemented above.
TI'Il..E DATE
7 X
8
9
PAr<\'
10
SIGNA UA
11 X
LOCAn N APP OVAL -" l8fl8Wul In
Cer1ilicabon of Local Zoning and Busin<l6S flegulBlDry Compliance. ORS 822.005 requires a vehicle dealer license, unless exempt
under ORS 822.Q15, lor any pelSOfl who:
(a) Buys, sells, brokers, trades or exchanges ...hides either outright or by means of any conditional sale, bailment, lease,
security inlerest, consignment or oIherwiee; OR
(b) Displays a new Dr used _iete, trailer or semitrailer for sale; OR
(c) Acts as any type of agent lor the owner of a vehicle to sell the vehicle or acts as any type 01 agent lor a pernon interested in
buying a vehicle 10 buy a vehicle.
THE CERTIFICATION BELOW IS TO BE COMPlETED BY Tl1E LOCAL ZONING OFFICIAL. Your lIIlProvaJ below should be base~
upon.whelher the applicant can do ANY of !he activities liSted in (a) through (0) above under your or<linances, at the location of the
bUSiness given on Line 2. Pursuant 10 ORS 822.025(8)(b)(A)(tl), applicant meets requirements below.
Iv; If1e zoning official fer If1e locality in lIf1id1 this businllSSis located, I vetily by my si!Jlalule billow lf1al the _ of this lAlslne9s as _ 0Il1his appf1Calion.
complies wilh any land .... anlinances and busine59 regulalory onIi,,"",,", allI1e . or ""'" ,as 8llPlOllria1e ptlrsuant 10 ORSIl22.025.6(a
l"ELEPHQNENUM EJ\
o COUNlYOF: if 1 d-- -23.0
1'11t ne/"
10 J I
Place li'lalmlPl or sea! I'lsrG
\J
. APPROVED
! ':.lTY OF SPRINGFIELD
L.
Date Received:
PRf(i.TIl-Oooo'1
(/0::,-)'-\--32- \L 300
Original Submittal