HomeMy WebLinkAboutApplication APPLICANT 7/28/2011
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APPLlCATIe>er/R
THREE YEAR VEHICLE DEALfR CERTIFICATE
AS A DEALER OR REBUILDER OF VEHICLES
CUSTOMER:NUMBER
t
. EFFECTIVE DATE
EXPIRATION DATE
I DEALER NUMBER
o ORIGINAL
o RENEWAL
1
2
If this is a renewal, do not complete the fee information. Use the attached
billing list to calculate your fees. The billing list MUST be submitted with your
renewal application.
Original Certificate (Includes one plate).................................
Additional Locations --er @$230.00 .....................
~~~~~~~~~Ip~=tion F~735-3~~~~i.: f~r.e.~~.h.IO.~.t~~.~~........
CER:rIFICATE FEE
LATE FEE
SUPPLEMENTALS
REN'EwAL 'PLATES'
ADDITIONAL PLATES
TEMPORARY,PLATES
OREGON REGISTRY NUM)l.ER (IF LLC OR CORPORATION)
1 3'=:,-'1<0
OREGON REGISTRY NO. BUSINESS TELEPHONE
~
crV
~L
e-
os
6
7
8
o New Vehicles
If corporation, list the state under
"'I'7l !!t'.!Q.h,.business is incorporated:
o Partnership 0 LLC ~ Corporation~6c>.u
Used Vehicles
o Yes ~ No
I/we sell NEW RECREATIONAL VEHICLES: 0 Yes ~ No
IF "YES," SERVICE FACILITY LOCATION (STREET AND NUMBER) CITY
If "Yes," name the makes >-
ZIP CODE
9
10
SIGNATURE
11 X
Date Received:
LOCATION APPROVAL (II renewal, required only il dealer is changing business location)
Certification 01 Local Zoning and Business Regulatory Compliance. ORS 822.005 requires a vehicle dealer license, unless exempt
under ORS 822.015, for any person who:
(a) Buys, seils, brokers, trades or exchanges vehicies either outright or by means of any ccndttional sale, bailment, lease,
security interest, consignment or otherwise; OR
(b) Dispiays a new or used vehicle, trailer, or semttrailer for s.ale; 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.
As the lOlling ofliciallor the locality in which this business is located, I verify by my signalure below that the location ot this business as slated OIl this application,
complies v.ith any land use ortlinances and business regulatory ortlinances ot the city or county, as appropriate pursuant to ORS 822.025.6(a)
I'7'i S .' TELEPHONENU~R I" 270 I
L6.J CITY OF: (\ 0 COUNTY OF: ( I ) /1 'f/ - J
PRINT AME VV\l \ (e TITLE 14 n n e,r r
DATE I ;) '{ {/
v
PiSl.C~ ~m~ or ~~Sl.~ Ihi~r~
v
JUL 2 8 2011
APPROVED
CITY OF SPRINGFIELD
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. rigina\ submittal
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