OBL251 (05/2015)
Occupational and Business Licensing
555 Wright Way
Carson City, NV 89711
(775) 684-4690
DEPOSIT RELEASE APPLICATION
Pursuant to Nevada Revised Statutes
Individual/Corporate Name: ________________________________ DMV Business License #___________________
DBA Name: ___________________________________________ Phone Number _________________________
(If applicable)
Mailing Address ___________________________________________________________________________
Street City State Zip
Physical Address__________________________________________________________________________
Street City State Zip
Type of Deposit:
☐Cash ☐Savings/Time Certificate No.____________________ ☐ Other __________________
Amount of Deposit: $________________________
Bank Name ________________________________________________________________________
Address ___________________________________________________________________________
Reason for Release ___________________________________________________________________
____________________________________________________________________________________
Principal’s Printed Name ________________________________________________________
Principal’s Signature _________________________________________ Date ________________________
State of Nevada
County of __________________
Subscribed and sworn before me this_______ day of_____________, __________by
______________________________________ __________________________________
Notary Public or Authorized Nevada DMV Representative (Notary Seal)
FOR DEPARTMENT USE ONLY
_______________________________________ _____________________☐ Approved ☐ Denied
Authorized DMV Representative’s Signature Date
_______________________________________ _____________________☐ Approved ☐ Denied
Supervisor/Manager’s Signature Date
_______________________________________ _____________________☐ Approved ☐ Denied
Administrator’s Signature (if applicable) Date
Reason for Denial: _______________________________________________________________________
