DO NOT STAPLE
Montana state authorities reserve the right to reject any form that has been altered.
MV25 (10/19) Page 2 of 2 This form is available in alternate formats for people with disabilities.
Section A: Ownership Information
State the full legal name, home address, date of birth, social security number, and driver license number or
tribal identification number of each person who has an ownership interest in the dealership. If the
licensee is a corporation, the same information for the corporate officers must be provided, indicating
capacity. (Corporate officers may have day-to-day responsibility for running the corporation.) If there are
additional owners or corporate officers a copy of this page must be used. Please type or print.
Full Legal Name
(as shown on your
government-issued ID)
Residential & Mailing Address
(street/city/state/zip)
Date of
Birth
Social Security No.
Driver License or
Tribal ID No.
(submit a copy)
Corporate
Capacity
1.
Felony Background: Has the individual listed above been found guilty of, or pled guilty to, a felony in Montana or elsewhere?
Yes_______ No_______ If yes, provide a summary of the conduct resulting in the felony determination or plea, including dates of conduct and any
court proceedings relating to conduct and name and address of court. Conduct Results:
Interests in Other Dealerships: Does the individual listed above have ownership interest in another dealership or wholesaler in Montana or
elsewhere? Yes_______ No_______ If yes, provide the name and address of each dealership or wholesaler.
2.
Felony Background: Has the individual listed above been found guilty of, or pled guilty to, a felony in Montana or elsewhere?
Yes_______ No_______ If yes, provide a summary of the conduct resulting in the felony determination or plea, including dates of conduct and any
court proceedings relating to conduct and name and address of court. Conduct Results:
Interests in Other Dealerships: Does the individual listed above have ownership interest in another dealership or wholesaler in Montana or
elsewhere? Yes_______ No_______ If yes, provide the name and address of each dealership or wholesaler.
3.
Felony Background: Has the individual listed above been found guilty of, or pled guilty to, a felony in Montana or elsewhere?
Yes_______ No_______ If yes, provide a summary of the conduct resulting in the felony determination or plea, including dates of conduct and any
court proceedings relating to conduct and name and address of court. Conduct Results:
Interests in Other Dealerships: Does the individual listed above have ownership interest in another dealership or wholesaler in Montana or
elsewhere? Yes_______ No_______ If yes, provide the name and address of each dealership or wholesaler.
Section B: Person designated to manage the business
If a person other than the owners or corporate officers listed above is designated to manage the business,
complete this section. Please type or print.
Full Legal Name
(as shown on your
government-issued ID)
Residential & Mailing Address
(street/city/state/zip)
Date of Birth Social Security No.
Driver License or Tribal
ID No.
(submit a copy)
Felony Background: Has the individual listed above been found guilty of, or pled guilty to, a felony in Montana or elsewhere?
Yes_______ No _______ If yes, provide a summary of the conduct resulting in the felony determination or plea, including dates of conduct and any
court proceedings relating to conduct and name and address of court. Conduct Results:
Section C: Certification
I ____________________________hereby certify under penalty of law (MCA 45-7-203 Unsworn Falsification to Authorities)
that on this date___________________________:
•
• I am the person named on this form
• The statements made and information contained on this form are true and correct to the best of my knowledge, information
and belief
• If signing for a business entity or trust, I have full authority to do so
• I authorize the insurance company to release all general liability insurance policy information to the state of Montana, Title
and Registration Bureau
• My name, as it appears above, is intended for the purposes of this document to be my genuine signature and
acknowledgment of this form.
• Applicant agrees to comply with the provisions of the Mont. Code Ann., and rules and regulations promulgated thereunder
applicable to motor vehicle dealers, distributors and manufacturers in effect on the date of this Application.
Electronically sign here to submit via email...................................
• Or sign below if scanning, faxing, or mailing form.
Signature of owner/corporate officer (If corporate officer, give title) (This is my legal signature) Date
Electronic signature of owner/corporate officer
click to sign
signature
click to edit
![]()
