Fillable DEPOSIT STATEMENT Occupational and Business Licensing 555 Wright (Department of Motor Vehicles )

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DEPOSIT STATEMENT Occupational and Business Licensing 555 Wright (Department of Motor Vehicles )

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OBL240 (Rev. 12/2019)
Occupational and Business Licensing
555 Wright Way
Carson City, Nevada 89711
684-4690
www.dmvnv.com
DEPOSIT STATEMENT
NRS 482, NRS 487, NAC 445B, and NRS 490
Licensee’s Name
DMV Business License #
Business Name
Address
Street
City
State
Zip
In lieu of a bond, licensee has placed a deposit with the Nevada Department of Motor Vehicles (NV DMV).
(Check the appropriate deposit)
:
1.
Cash in the amount of $
2.
Savings/Time Certificate - Account No
In the amount of $
Bank/Credit Union Name:
Physical Address:
Street City State Zip Code
Representative’s Name:
Phone:
Please initial next to each statement.
I understand a deposit may be disbursed by the Director of NV DMV, in an amount determined by the Director to
compensate a person injured by an action of the licensee.
I understand if the amount of the deposit is reduced or there is an outstanding court judgment for which the licensee is
liable under the deposit, the business license is automatically suspended.
I understand that upon satisfactory evidence that there are no outstanding claims against the deposit, a
deposit may be refunded by order of the Director 3 years after the date the licensee ceases to be licensed by the NV
DMV pursuant to NRS 482, 487, 490, or 1 year after the date the licensee ceases to be licensed by the NV DMV
pursuant to NAC 445B.
I understand pursuant to provisions contained in NRS Chapters 482, 483, 485, 487, 445B, 597, and NAC 445B, if I
deposit a Savings/Time Certificate with NV DMV, it must be issued by a bank/credit union situated in the State of
Nevada and I must provide NV DMV a written letter from the bank/credit union stating the funds in the amount and
account indicated above are unavailable for withdrawal except upon order of the NV DMV.
I acknowledge a deposit in lieu of a bond has been placed with the Nevada Department of Motor Vehicles under the terms prescribed
by the NV DMV and pursuant to provisions contained in NRS and NAC.
Printed Name and Signature of Business Principal
Date
State of Nevada County of
Subscribed and sworn before me this
day of
________________________________________________________ ______________________________________________________
Notary Public or Authorized Nevada DMV Representative (Notary Seal)
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DEPOSIT STATEMENT Occupational and Business Licensing 555 Wright (Department of Motor Vehicles )

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Completed 24 December 2020

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