Tony Evers, Governor
Craig Thompson, Secretary
Internet: wisconsindot.gov
Telephone: 608-266-1425
Facsimile (FAX): 608-267-0323
E-mail: DealerLicensingUnit@dot.wi.gov
Ownership Change Addendum
The WI DOT Dealer and Agent Section has received notification you wish to change ownership within your partnership, corporation,
business or, LLC. We require that you verify and sign the statement(s) below.
Section A – To be completed by existing majority legal owner.
I, , have examined the original application, or a copy of, dated
(Controlling Interest Legal Owner Name)
for and verify the information continues to be true and correct with
(Legal Business Name)
exception to the ownership change taking place on this date, . My signature below affirms no other changes have
been made and I continue to be in full compliance with all licensing requirements necessary to maintain daily business operations.
(Signature of the Controlling Legal Owner Name/Date)
Section B – To be completed by previous owner. If more than one, complete a separate Ownership Change Addendum for
each previous owner.
I, , have examined the original application, or a copy of, dated
(Previous Owner Name)
for and verify that I am no longer an owner nor do I hold any interest
(Legal Business Name)
in .
(Legal Business Name)
(Signature of the Previous Interest Owner Name/Date)
Subscribed and sworn to before me this day of , 20 .
(Sign by the Notary Public, State of Wisconsin)
My Commission Expires:
Please sign this form, make a copy for your records and return the original to:
WI DOT Dealer and Agent Section
4822 Madison Yards Way, Box 7909
Madison, WI 53705
