Place a check mark in the box below, stating that you have no intention to apply for, nor have applied for a Manufacturer's license. Failure to check the box, will
result in a Dealer's or Repairer's license NOT being issued.
APPLICATION FOR AUTOMOBILE DEALER'S
OR REPAIRER'S LICENSE
K-7 REV. 7-2016
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS:
1.
2.
3.
SECTION 1 must be completed by APPLICANT
SECTION 2 must be completed and signed by local authorities of the city or town in which the location is proposed.
Submit application and supporting documents to: DEPARTMENT OF MOTOR VEHICLES, DEALERS AND
REPAIRERS SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161-2011.
DMV USE
ONLY
LICENSE NUMBER
SECTION 1: BUSINESS INFORMATION
SECTION 2: CERTIFICATE OF LOCAL APPROVAL FOR PROPOSED LOCATION
TYPE OF LICENSE
NEW CAR
DEALER
USED CAR
DEALER
GENERAL
REPAIRER
LIMITED
REPAIRER
NAME UNDER WHICH BUSINESS OF APPLICANT IS TO BE CONDUCTED
FULL ADDRESS OF LOCATION FOR WHICH LICENSE IS REQUESTED (Use separate application for each location)
MAILING ADDRESS, IF DIFFERENT FROM ABOVE
TYPE OF OWNERSHIP
INDIVIDUAL PARTNERSHIP CORPORATION LLC
DEEP PERMIT IF APPLICABLEIF INCORPORATED OR LLC, UNDER LAWS OF WHICH STATE
THE BUSINESS HOLDS A FACTORY FRANCHISE TO SELL THE FOLLOWING MAKE(S) OF VEHICLE(S) AT THE ABOVE LOCATION
If applicant firm is owned by individual or partnership, enter data below for all owners. If owned by a corporation enter data for principal officers or major stockholders. If LLC, enter members and managers.
TITLE NAME HOME ADDRESS DATE OF BIRTH SEX
CERTIFICATION (To be signed by Owner, Partner, Managing Member, or Authorized Officer in presence of Notary)
Pursuant to CGS 53a-157b, I
declare that the statements made
by me in this application or in any
documents attached hereto are
true and complete to the best of
my knowledge and belief.
SIGNED (Owner, partner, major stockholder or authorized officer)
X
TITLE
Subscribed and sworn
to before me:
DATE SIGNED (Notary Public, Justice of Peace, or Commissioner of Superior Court)
X
Pursuant to CGS 14-54, local approval is hereby granted for the above named firm or individual to conduct a business of the type checked below at the location
specified in this application.
Signatures of Building Official and Fire Marshal indicate compliance with applicable laws and regulations.
TYPE OF BUSINESS APPROVED
NEW CAR
DEALER
USED CAR
DEALER
GENERAL
REPAIRER
LIMITED
REPAIRER
PROPOSED LOCATION ADJOINS
STATE
HIGHWAY
LOCAL
ROAD
EXAMINER INITIALS
E-MAIL ADDRESS
I have not applied and do not intend to apply for a Manufacturer's license.
DISTRIBUTION: White - D & R Copy Canary - License Copy Pink - Audit
SIGNATURE OF BUILDING OFFICIAL
X
PRINT
DATE
SIGNATURE OF LOCAL FIRE MARSHAL
X
PRINT
DATE
TITLE DATE
X
SIGNATURE OF AUTHORIZED OFFICIAL
Are there any restrictions placed on
the licensee's use of the property?
NO YES (If "YES", a copy of the restrictions MUST be attached to this application.)
PRINT
PAGE 1 OF
click to sign
signature
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