Fillable Application for: MOTOR VEHICLE WRECKER OR SALVAGE DEALER (Nebraska)

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Application for: MOTOR VEHICLE WRECKER OR SALVAGE DEALER (Nebraska)

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DLB-10A Revised 10-2018
NEBRASKA MOTOR VEHICLE INDUSTRY LICENSING BOARD
301 CENTENNIAL MALL SOUTH, P.O. BOX 94697, LINCOLN, NE 68509
Telephone: 402-471-2148 Fax: 402-471-4563 Website: http://mvdealerbd.ne.gov
LICENSE FEE: $200
(The fee is collected after the wrecker/salvage dealership has been inspected and approved by our office.)
Application for: MOTOR VEHICLE WRECKER OR SALVAGE DEALER LICENSE
1. Application of _____________________________________________________________________________
___
__
(Name of wrecker/salvage dealership under which business is conducted)
for a license to engage in the business of selling or exchanging motor vehicle or trailer parts and accessories in accordance with the Motor Vehicle
Industry Regulation Act, the rules and regulations adopted and promulgated by the board, and any amendments existing on the date of application,
and in connection herewith makes the following Material Statements:
2. Address of wrecker/salvage dealership:
______________________________________________________________________________________________
_
(Street) PO Box (City) (State) (Zip Code)
County: _________________________ If the above address is a rural location, please give directions to find the dealership:
___________________________________________________________________________________
___
_____
____
Name and telephone number of the person to contact to schedule the inspection:
______________________________________________________________________________
________
______
____
3. (a) Your declared office hours: _______ a.m. to _______ p.m. (must be open 40 hours per week, 20 of those during
regular business hours)
(b) Dealership Telephone Number: (______)______________ FAX: (______)______________
The telephone number for the dealership must be in the dealership name and listed with Directory Assistance.
(c) email address for the dealership: __________________________________________________________________
Name of person to contact for the dealership: ______________________________________________
____________
4. Does the dealership location conform to applicable zoning laws? ___________
Submit a zoning permit or letter from the proper authority confirming your zoning compliance.
5. Describe fully the building and actual premises where the business is or will be operated (including square feet of
building and lot).
_______________________________________________________________________________________________
6. Indicate whether the proposed location is owned or leased by the applicant _________________. If the location is
leased, a copy of the lease that does not end before December 31st of the license year must accompany this application.
7. Will the building and actual premises be maintained as a bona fide and established place of business? __________
___
8. Will the wrecker or salvage dealer records be kept separately from other business or personal records? ___________
__
9. Submit with this application a photograph of the place of business, showing the permanently erected dealership sign in
the photo. (The dealership name on the sign must be in letters at least eight inches in height.)
DLB-10A Revised 10-2018 (Wrecker Salvage Dealer)
10. Ownership of the dealership (check only one):
___ Individual Owner: name, address and social security number of the Individual Owner
__________________________________________________________________________________________
____
__
Social Security Number _________________________
___ Partnership: list the names and addresses of all partners
______________________________________________________________________________________________
__
______________________________________________________________________________________________
__
___Corporation or Limited Liability Company: ___________________________________________________
_____
(must be registered with Nebraska Secretary of State)
List the names, addresses, and titles of principal officers of the corporation or names and addresses of members of the LLC
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
11. Have any of the named owners:
(a) Ever been found guilty of any felony that has not been pardoned?
(b) Ever been found guilty of any misdemeanor concerning fraud or conversion?
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
Yes ____ No ____
(c) Suffered any judgment in any civil action involving fraud, misrepresentation
or conversion?
(d) Are any felony charges pending against any of the owners at the present time?
OATH
(All partners must sign the oath)
STATE OF NEBRASKA )
County of ________________________ )
________________________________________________________, being first duly sworn, upon oath deposes and says:
(printed name of individual owner, partners, corporate officer, or LLC member)
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.
_______________________________________ ______________________________________
Signature of applicant Signature of applicant
SUBSCRIBED in my presence and sworn to before me this _____day of __________________, _______
_____________________________________________________
(Notary Public)
Submit the completed wrecker/salvage dealer license application and supporting documents to our office. It will be
forwarded to one of our investigators who will contact the applicant to schedule an appointment to inspect the dealership.
No fee is collected until after the wrecker/salvage dealership has been inspected and approved by our office.
After the inspection and upon approval, send to our office the Inspection Report, any additional required items, and the
fee in the proper amount made payable to the Motor Vehicle Industry Licensing Board.
If YES, please give details. Attach a separate sheet of
paper if needed.
_______________________________________________________________________________________________
The Motor Vehicle Wrecker or Salvage Dealer must maintain a bona fide and established place of business that conforms
with applicable zoning laws, has office space, posted business hours, a telephone listed with directory assistance in the
dealership name, and a permanently erected sign in the dealership name.
Nebraska statutes 60-1401 thru 60-1440 and 60-2601 thru 60-2608 can be viewed at www.nebraska.gov .
• The name of the wrecker/salvage dealership must reflect the nature of the business for which the license will be
granted (auto parts, auto salvage, etc.) Please call or contact our office if you have any questions about the suitability
of the dealership name.
Below are examples of issuance of the wrecker or salvage dealer license to reflect ownership and the
dealership name.
Ø If applying as an individual owner: John Doe dba John D’s Auto Salvage
Enter John D’s Auto Salvage on item 1 on the application, and John Doe on item 10, Individual owner.
Ø If applying as a partnership: John and Mary Doe dba Doe’s Auto Salvage
Enter Doe’s Auto Salvage on item 1 on the application, and John Doe & Mary Doe as partners on
item 10, under Partnership
Ø If applying as a corporation or LLC in which the name already reflects ‘auto parts’ or ‘auto
salvage’, for example: John Doe Auto Parts, Inc. Enter John Doe Auto Parts, Inc. on item 1 on t
he
application and list names and titles of corporate officers on item 10 under corporation or LLC.
Ø If applying as a corporation or LLC in which a dba (doing business as) is required: John Doe
Enterprises LLC dba John’s Auto Parts. Enter John’s Auto Parts on item 1 of the application, and
John Doe Enterprises LLC on item 10 under corporation or LLC and list names & addresses of the
LLC members.
Dealerships with a corporation or LLC as the ownership must have the corporation or LLC registered
with the Nebraska Secretary of State – Business Services. In the last example, “John Doe Enterprises
LLC” would be registered with the Nebraska Secretary of State; the dealership sign, telephone listing,
and any advertising would be in the dealership name, “John’s Auto Parts.”
Submit the completed wrecker/salvage dealer license application and supporting documents to our office. It will be
forwarded to one of our investigators who will contact the applicant to schedule an appointment to inspect the dealership.
No fee is collected until after the wrecker/salvage dealership has been inspected and approved by our office.
After the inspection and upon approval, send to our office the Inspection Report, any additional required items, and the
fee in the proper amount made payable to the Motor Vehicle Industry Licensing Board.
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Application for: MOTOR VEHICLE WRECKER OR SALVAGE DEALER (Nebraska)

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Completed 6 April 2022

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