The MV-372 form plays a pivotal role for individuals or entities seeking to establish or extend operations as a Private Service Bureau within the jurisdiction of the New York State Department of Motor Vehicles (NYS DMV). Crafted to meticulously guide applicants through the comprehensive process, the form outlines a clear path from submission to approval, beginning with an original application fee and an additional charge for any branch office intended to be operated. Furthermore, it ensures all pertinent information is submitted, including personal and business identifiers which are crucial for compliance with state regulations. The sections within the form are designed not only to capture the essence of the business, including the type and detailed information about owners, partners, and officers but also to underscore the importance of adherence to specific conditions set forth by the state for operational integrity. These include maintaining adequate records, ensuring the credibility of employees, and abiding by all relevant state laws and municipal ordinances to uphold public health and safety. Beyond operational details, the MV-372 form also serves as a testament to the integrity of the applicant, emphasizing the severe implications of falsifying information. This rigorous application process underscores the New York State's commitment to maintaining a high standard among private entities involved in public service provisions, thereby ensuring that only qualified and responsible businesses can facilitate DMV-related services to the public.
| Question | Answer |
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| Form Name | Form Mv 372 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | mv372 new state dmv psb fees form |
OFFICE USE ONLY
Application No. |
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Lic. # |
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New York State Department of Motor Vehicles |
FEE SCHEDULE |
APPLICATION FORALICENSE TO |
OriginalApplication.......... $25.00 |
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OPERATEAPRIVATE SERVICE BUREAU |
Branch Office(per branch)...$ 1.50 |
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OR OPENABRANCH OFFICE |
An additional $25.00 license fee will |
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be required upon approval |
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INSTRUCTIONS: u Print or type the information in this application.
uRefer to the Private Service Bureau page of the NYS DMV website (http://www.dmv.ny.gov/psb.htm) for information about the documents that must accompany this application.
Name of Private Service Bureau |
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Federal Employer ID Number* |
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Date ofApplication (Mo./Day/Yr.) |
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MailingAddress of Private Service Bureau (Street & No.) |
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If you also plan to operate a branch office, provide the branch office address: |
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Telephone |
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Type of Business (check one of the following): |
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Sole Proprietor |
Partnership |
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Corporation |
Association |
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Listnames,addressesandsocialsecuritynumbersofallowners,partners,corporationofficers,stockholdersandmanagers,(continueonadditionalsheet,ifnecessary). |
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Name |
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Social Security Number* |
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Address |
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Owners |
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Partners |
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Corp. Officers |
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Managers |
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Major Stockholders |
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*AsrequiredbySection5oftheNYSTaxLaw,thesocialsecuritynumberofindividualsandtheFederalEmployerIDNumberofbusinessesregulatedby |
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theDepartmentofMotorVehiclesmustbegiventotheNewYorkStateDepartmentofTaxandFinance. |
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ANSWERALL QUESTIONS IN THE FOLLOWING SECTION: |
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CHECK ONE |
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Yes No |
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1.Haveanyoftheowners,partners,corporationofficers,managersormajorstockholderseveroperatedaPrivateServiceBureaubefore?
(IfYES,complete“Explanations”sectionbelow bygivingdatesofoperationandreasonfordiscontinuanceifnotstillinoperation). . . . . . . . . .
2.WhereisyourPrivateServiceBureauoperatedfrom? (forexample,officespace,residence,etc.) ________________________________
3.IsthePrivateServiceBureauconductedinconjunctionwithanyotherbusiness? .................................................
IfYES,whatkindofbusiness?_________________________________________________________________________________________
4.IsyourPrivateServiceBureauwithin1500feetfromtheneareststateorcountyofficewheredriverlicense’sorvehicleregistrationsareissued?...
5.Doyoushareofficespaceordeskroomwithanyotherbusiness? .............................................................
IfYES,whatkindofbusiness?____________________________________________________________________________
EXPLANATIONS
Page 1 of 2 |
EMPLOYEES/RUNNERS/AGENTS (PAID OR UNPAID)
Listallemployees/runners/agents(paidorunpaid)workingat orassociatedwiththePrivateServiceBureau.
Name |
Address |
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NYS Driver
*Note: ALL EMPLOYEES/RUNNERS/AGENTS (PAID OR UNPAID) WHO HAVE DIRECT
CONDITIONS
Asaconditionforissuing aPrivateServiceBureauLicense,theundersignedagreetoallofthefollowingconditions:
A. Tomaintainadequaterecords,asrequiredbytheNewYorkStateVehicleandTrafficLawandRulesandRegulations,andtopermittheinspectionof suchrecordsatreasonabletimesbyanauthorizedrepresentativeofDMV.TheDepartmentofMotorVehiclesconsiders“reasonabletime”tobe 9:00A.M.to5:00P.M.,MondaythruFriday.
B.Nottoemployoruseemployees/runners/agents(paidorunpaid)whohavebeenconvictedofafelonyormisdemeanorunlesseachemployeeis approvedbytheCommissionerofMotorVehicles.
C.Tocomplywithallstatelawsandregulations,andallmunicipalordinancesandregulationsrelatingtopublichealthandpublicsafetyforthebusinessfacility.
D.TocomplywithallprovisionsoftheNewYorkStateVehicleandTrafficLawandRulesandRegulationsrelatingtoaPrivateServiceBureau.
AFFIRMATION
Alloftheundersignedaffirmtheyhavereadtheentireapplication,arefamiliarwithallitscontents,andallanswers,statementsandallothermattersinitaretrue. Eachowner,partner,manager,corporationofficerandmajorstockholder(20%OR MORE)ofthePrivateServiceBureaumustsigninthespaceprovidedbelow.
1) |
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2) |
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8) |
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9) |
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10) |
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Signature |
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To knowingly make a false statement or conceal a material fact in this application is a criminal offense, and will result in the revocation of your Private Service Bureau License. False statementsare punishable under Section 210.45 of the Penal Code.
Pursuant to Vehicle and Traffic Law - 392, any person knowingly making a false statement in an application for any document issued by the Department or in any proof or statement in writing in connection with such an application shallbe guilty of a misdemeanor.
Vehicle and Traffic Law - 394(5) authorizes the Department to suspend or revoke a Private Service Bureau license or refuse to issue a renewal thereof where the licensee has made a material false statement or concealed a material fact in connection with his or her application for a licenseorrenewal.
Please return this form with all required documentationandapplicationfeeto:
PrivateServiceBureauUnit NYSDepartmentofMotorVehicles 6EmpirePlaza,Room322P AlbanyNY 12228
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