Class I, II & III Motor Vehicle - Boston
[Pages:18]Class I, II & III Motor Vehicle Dealer Application
Important note: If the applicant has not held a motor vehicle dealers license in the year prior to this application, the applicant must file a duplicate of this application with the Registrar of Motor Vehicles.
I, the undersigned, duly authorized by the concern herein mentioned, herby make application to the Police Commissioner for the City of Boston for a
Class 1 {New}
Class 2 {Used}
Class 3 {Motor Vehicle Junk License}
to buy, sell, exchange or assemble second hand Motor Vehicles or parts thereof, in accordance with the provisions of Chapter 140, Section 58 and 59 of the Massachusetts General Laws
This is an application for a [ ] New or [ ] Renewal of a current license, license number________.
What is your name?:_________________________________________________________________________
What is your address?: _______________________________________________________________________
What is your phone number?: _________________________________________________________________
What is the name of the business?______________________________________________________________
What is the business address and phone number?__________________________________________________
_________________________________________________________________________________________
Is this business operated individually, as a partnership or as a corporation?______________________________
If not operated as a corporation, do you have a current Business Certificate from the City of Boston?_________
If not operated as a corporation, are there any other co-owner(s)?
Yes No
Please provide the co-owner(s) name(s) and addresses: _____________________________________________
__________________________________________________________________________________________
If you are a corporation, please list the name of the corporation along with the names and residential addresses of the
President, Vice President, Secretary and Treasurer:
Corporate name: ____________________________________________________________________________
President: _________________________________________________________________________________
Vice President:_____________________________________________________________________________
Treasurer: _________________________________________________________________________________
Secretary:_________________________________________________________________________________
Will your principal business be the sale of new motor vehicles?
Yes
No
Are you a recognized agent of a motor vehicle manufacturer?
Yes
No
Do you have a signed contract with the manufacturer as required by MGL C. 140 ? 58 (b)?
Yes No
If yes, which manufacturer are you an agent of: ________________________________________________
Will your principal business be the buying and selling of secondhand motor vehicles?
Yes No
Will your principal business be that of a motor vehicle junk dealer?
Yes
No
Have you ever had a license application for any class of motor vehicle dealer denied,
suspended or revoked? Yes No. If yes, please provide details:____________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________
Do you currently have or have you had any consumer protection complaints lodged against you at either the Mayors
Office of Consumer Affairs or the Massachusetts Office of Consumer Affairs? If yes, please
describe:___________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
______________________________________________________
Do you currently have a bond in effect as required by MGL C. 140 ? 58 (c)?
Yes No
What is the name, address and phone number of the repair facility that you will use?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
________
Have you included an affidavit of Proper Repair Facilities with this application?
Yes
No
Are you currently issued Dealer Plates by the Massachusetts Registry of Motor Vehicles? Yes No
If yes, please list the plate numbers:___________________________________________________________
__________________________________________________________________________________________
Please give a complete description of the building and premises to be used for the purpose of operating the business: ______________________________________________________________________________
__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Do you currently possess copies of the plot plan, use and occupancy permit, building certificate and any other
permits that may be required for use of the intended location?
Yes
No
Signed under the pains and penalties of perjury that the above statements are true:
________________________________ Date
________________________________________________ Signature
On this ____________ day of ____________, 20________, before me, the undersigned notary public, personally appeared ___________________________________________ (Name of document signer), proved to me through satisfactory evidence of identification, which were _________________________________________, to be the person who signed on the preceding or attached document in my presence, and who swore or affirmed to me that the contents that the contents of the document are truthful and accurate to the best of (his (her) knowledge and belief.
______________________________________________(Official signature and seal of notary)
My commission expires___________________________
Location inspection and documentation review conducted by:
Notes:______________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________
Application recommended to be approved for issuance of a Class __________ License for _____________ Motor Vehicles
Application recommended to be denied at this time.
________________________________ Date
________________________________________________ Signature
10 / 2009
................
................
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