DLB-1A |
FEE $ 200.00 |
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(Collected after inspection & approval) |
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STATE OF NEBRASKA |
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NEBRASKA MOTOR VEHICLE INDUSTRY LICENSING BOARD |
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301 CENTENNIAL MALL SOUTH, P.O. BOX 94697, LINCOLN, NE 68509 |
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APPLICATION FOR |
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(INDICATE THE CLASS OF DEALER BY PLACING AN "X" IN THE APPROPRIATE BLOCK.) |
COMBINATION MOTOR VEHICLE & TRAILER DEALER LICENSE
(Used motor vehicles/motorcycles/trailers ) |
(Enfranchised motor vehicles/motorcycles/trailers ) |
□ TRAILER DEALER LICENSE (New and/or used Trailers only)
□ MOTORCYCLE DEALER LICENSE (New and/or used Motorcycles only)
Application for a license to engage in the business of selling or exchanging motor vehicles or trailers in accordance with Ch. 60, art. 14, R.R.S., 1943, as amended, and in accordance with rules and regulations of the Nebraska Motor Vehicle Industry Licensing Board, as the same may be now, or as amended hereafter:
1. Applicant is doing business as (name of the dealership): ______________________________________________________________
_____________________________________________________________________________________________________________
(Street)(PO Box) (City, Town or Village) (State) (Zip Code) (County)
If the above address is a rural location, please give directions to find the dealership.
____________________________________________________________________________________________________________
2.Does the above location conform to applicable zoning laws?____________
(Please supply a zoning permit or letter from the proper authority confirming your zoning compliance.)
3. |
Indicate your declared office hours: From_______A.M. to_______P.M. |
Dealership Phone Number (________)________________ |
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(Must be open 40 hours per week - 20 of those during regular business hours.) |
FAX Number ( |
)________________ |
4. |
Ownership of the dealership (check only one): |
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Individual: name and address of individual owner__________________________________________________________________
Partnership: names and addresses of all partners___________________________________________________________________
____________________________________________________________________________________________________________
□ Corporation or LLC: ___________________________________________________ (registered with the Nebraska Secretary of State)
List the names, titles and addresses of principal corporate officers or names and addresses of LLC members:
(SEE THE INSTRUCTIONS REGARDING THE ISSUANCE OF THE DEALER BOND TO REFLECT OWNERSHIP)
5.Describe fully the building and actual premises where the business is to be operated (include square feet of building and display area):
6.Indicate whether the proposed location is owned or leased by the applicant ______________. If the location is leased, a copy of the lease not ending before Dec. 31st of the current year must accompany this application.
7.Will there be one contiguous area for the display of ten or more motor vehicles, trailers, or motorcycles in a presentable manner where this business is to be operated? ____________
8.Will all trailer or motor vehicle and trailer records be kept separately and apart from other business or personal records?_____________
9.Will applicant maintain facilities to repair trailers or motor vehicles?
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YES |
Complete the “Service Facilities Statement” (top section). |
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NO |
Complete the “Service Agreement Statement” (lower section) or attach an executed service agreement for such repairs. |
10. (a) Have any of the above named persons ever been found guilty of any felony that has not been pardoned? |
Yes____No____ |
(b) Ever been found guilty of any misdemeanor concerning fraud or conversion? |
Yes____No____ |
(c) |
Suffered any judgment in any civil action involving fraud, misrepresentation or conversion? |
Yes____No____ |
(d) |
Are any felony charges pending at the present time? |
Yes____No____ |
If any of the above named persons answered yes to any of the above questions, please give details._____________________________
____________________________________________________________________________________________________________
11.Give the number of salespeople (including the free salesperson) who are to be licensed.______________
12.Name(s) of New Motor Vehicles, Motorcycles and/or Trailers which applicant is enfranchised to sell:
13.Name(s) of Manufacturer or Distributor who has enfranchised the applicant: (Please include copies of franchise agreements or contracts.)
____________________________________________________________________________________________________________
(Name of Manufacturer or Distributor) (Street) (City)(State) (Zip Code)
____________________________________________________________________________________________________________
(Name of Manufacturer or Distributor) |
(Street) |
(City) |
(State) |
(Zip Code) |
IMPORTANT: THE PROPER OATH MUST BE SIGNED |
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PERSONAL OATH |
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STATE OF NEBRASKA |
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County of________________________ |
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_____________________________________________, being first duly sworn, upon oath deposes and says: That he/she is the applicant who makes the
above and foregoing application, that he/she has read the same, knows the contents thereof, and that all statements therein contained are true.
__________________________________________________________
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(Signature of Applicant) |
SUBSCRIBED in my presence and sworn to before me this___________day of______________________________, ________ |
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__________________________________________________________ |
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(Notary Public) |
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PARTNERSHIP OATH |
STATE OF NEBRASKA |
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County of________________________ |
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_____________________________________________ and_________________________________________________, being first duly sworn,
upon oath deposes and says: That they are qualified members of _____________________________________________________ a partnership
(firm) (association) and are duly authorized to make this application and verification and have executed the same for themselves and all members thereof, and for and on behalf of said partnership (firm) (association); that they have read the above and foregoing application, know the contents thereof and that all statements therein contained are true.
___________________________________________________ |
____________________________________________________ |
(Signature of Partner) |
(Signature of Partner) |
SUBSCRIBED in my presence and sworn to before me this___________day of____________________________, _________
_________________________________________________________
(Notary Public)
CORPORATION or LIMITED LIABILITY COMPANY OATH
STATE OF NEBRASKA |
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County of________________________ |
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_________________________________________and__________________________________, being first duly sworn, upon oath deposes and says:
That they are the President and Secretary, respectively, or members of______________________________________________a Corporation or Limited
Liability Company; that they have executed the above and foregoing application under the authority and on behalf of said Corporation or Limited Liability Company, that they have read the same, know the contents thereof and that all statements therein contained are true. Statements are made by said Corporation or Limited Liability Company and by themselves individually, and as such officers or members of said Corporation or Limited Liability Company.
________________________________________________ |
__________________________________________________ |
(Signature of President) |
(Signature of Member) |
________________________________________________ |
__________________________________________________ |
(Signature of Secretary) |
(Signature of Member) |
SUBSCRIBED in my presence and sworn to before me this___________day of___________________________, ________
_______________________________________________________
(Notary Public)
IMPORTANT: DO NOT SEND ANY MONEY UNTIL AFTER THE APPLICATION HAS BEEN APPROVED. UPON APPROVAL OF YOUR APPLICATION PLEASE SEND EITHER A CERTIFIED CHECK, POSTAL MONEY ORDER OR CASHIER'S CHECK IN THE PROPER AMOUNT, MADE PAYABLE TO NEBRASKA MOTOR VEHICLE INDUSTRY LICENSING BOARD.
A CORPORATE SURETY BOND, A CERTIFICATE OF AUTOMOBILE LIABILITY INSURANCE/WORKERS COMPENSATION, AND A PHOTOGRAPH OF THE SIGN MUST ACCOMPANY THIS APPLICATION.
