TOWN OF DOUGLAS
CLASS II LICENSE APPLICATION
MGL c140 - Buy, Sell, Exchange or Assemble Second Hand Motor Vehicles
or Parts Thereof
Applicant Name:
Business Name:
Business Address:
Mailing Address:
Individual
Business Organization, check one of the following:
co-partnership association corporaton * attach Articles of Organization from the Secretary of State.
Busines Phone Number:
Purpose of
license:
Discription
of
premises:
* Please provide a blue print, or a drawn to scale diagram of the proposed premises.
Per MGL c90(7N1/4), do you have an association with a Repair Facility?
YES
NO
If yes, provide name and address:
Have you ever applied for a Class II license before?
YES NO
If yes, what Town?
Did you recive a License?
YES NO
If Yes, for what year?
Has any Class II licensed issued to you in Massachusetts or any other state ever been suspended or revoked?
YES NO
Per MGL c140(58), do you have a $25,000 Bond?
YES NO
I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state
tax returns and paid all state taxes required under law.
Signature
Title:
Date:
To the Licensing Authority;
The undersigned hereby applies for a License in accordance with the provisions of the Statutes relating thereto.
